2794 / / i LOT NO. v
PP 'IC N FOR GAS PERMIT
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OF CUPERTINO
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(APR 171964
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° ' Da 196 Permit No.
3 uur I Itl Fee $
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° Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
N and/or appliances in accordance with the provisions of the Plumbing Code of the City
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z W of Cupertino, and all other laws applicable. thereto.
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J ° y CONTRACTOR, AGENT
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i o State License S l Approved
/� PLUMBING INSPECTOR
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Remarks (Check d)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wal 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 Size oain
Gas Piping Fees �O
Tested and Approved ..r..�.�. ... -. ._ .._.................._--
DATE INSPECT00.