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.A PPLIVIFOR GAS PERMIT
z i APR 1 7 19FATC TIY.OFi CUPERTINO
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Fee
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° 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 m and/or appliances in accordance with the provisions of the Plumbing Code of the City
z W of Cupertino, and all other laws applicable thereto.
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PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
G,ravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GAS PI!VG
Number of Outlets $ize o Main
Gas Piping Fees
Tested and Approved ..... . t
AT \ INSPECTOR
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