2779 LOT NO. /
APPLIC I]i FOR GAS PERMIT
w Z APR 17 1964CI�'"1J OP CUPERTINO
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z2l3Date ;;�I96 Permit No. � .—
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_ Fee$
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0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
o and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
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Ilse of P emises
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O CONTRACTOR,AGENT'
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< o State License ��5� I Approved
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PLUMBING INSPECTOR
Remarks (Check ✓)
'Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Cirailating Heaters
_
-Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
~Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPIN n
Number of Outlets Si a o /jMain I
Gas Piping Fees ,S. /
Tested and Approved ....... . . . .. ..�/. _.... ../.._SP..._......_.............
D E ' INSPECTOR