51145 (2) R /Y �/ ✓r LOT NOM
NO. REST
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ICATION FOR GAS PERMIT
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3 u Unte 2 2 1266 96— Permit No.
WLL Fee $ ze
o C11 ,Arpp�ptiotPi����?!� by-,�a,�g�to the City of Cupertino for a permit to install gas pipes
o . and/or gas appliS sq it sfedtgh the reverse side hereof, and agrees to install said pipes
r and/or appliances in accordance with the provisions of the Plumbing Code of the City
wof Cupertino, and all other laws 1pplicable ereto.
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Remarks (Check ✓)
Type of Appliance Units Fees New Replace 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
(NAMF TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees �.
Tested and Approved ................ ._....,..........................---_...............
DATE INSPECTOR