2785 LOT NO.
CA�,�ION FOR GAS PERMIT
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° � Da & Ti � '�496 Permit No. 62
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O 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 a 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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w Use of Premises
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CONTRACTOR, AGENT
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o0 State License /�-5-�9� Approved
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a PLUMBING INSPECTOR
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Remarks (Check ✓)
,Type of Appliance Units Fees New Replace I Relocate
Gas Ranges _
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles:
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets I I Size o Main I
Gas Piping Fees I "' I �,,
Tested and Approved .. \ .... ... ..,.._...._....................
INSPECTOR