2808 LOTNO.
-
NO. STREET
NAPCgttqr�rr����i'•••!ON FOR GAS PERMIT
w i TY OF CUPERTINO
LEM; 5 1964
° J Date 196_ Permit No. r
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° CITYlicaTfOn is'fiYrCbFMaH��tbt�the City of Cupertino for a permit install gas pipes
o a 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
< w of Cupertino, and all other laws applicable thereto.
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a Use of Premises
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Stale License/ S 33 3 Approved 'LZ
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'tt PLUMBING INSPECTOR
Remarks (Check d)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
-Cas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING,
Number of Outlets Size o Main
Gas Piping Fees
Tested and Approved .,.... . .._..L. . .. .....__.....
.,.L ....................._.....
DATE - INSPECTOR