2832 LOT NO.
'NO. STREET
PLIION FOR GAS PERMIT
z `- TY OF CUPL'RTINO
, 0 F( JIUIL 2 01964 °
3 a D 196 Permit No.
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phc on Is ere y 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
> 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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Use of Premises k----x----"—�—'-
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o E State License 773c'd I Approve
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11 „n PLUMBING INSPECTOR
Remarks (Check d)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Cirollating Heaters -
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators /
Griddles
Steam Tables
Gravity Furnaces '
Suspended Unit e
Floor Furnace
Miscellaneous
NAME TYPE)
i
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees �;5y .1 /
. Tested and Approved- ..:/`�..—..."�Y:...�.. ... . . ........
. . ..
DATE INSPECTOR