2487 P"U,3 S� V �h t G� �, W'A`/ LOT NO. o� _
A P�.ICATION FOR GAS PERMIT
/ AUG 13 1963CITY OF CUPERTINO
\ CITVatflvF 91p 1..1!
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates 1 II
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles I�
Steam Tables
Gravity Furnaces �I
Suspended Unit I II
Floor'Furnace _
Miscellaneous it i
NAME TYPE)
I I II I I
I I II I I
II
Appliance Fees
,Inspected and Approved ...... .....:. ..............................................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
GasJ Piping Fees
Testedand Approved . ....................I...............................................
SATE INSPECTOR