2719 B LOT N0, l-' 4
APPLICATIOiJ FOR GAS PERMIT
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('p�t�R I 1964 CLOP CUPERTINO
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3 a DateW. a . vt WWI L. 'r �,t�9(,t Permit No. L
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F o Application is hereby made to the City of Cupertino for a permit to install gas pipes
'o r 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
a w of Cupertino, and all other aws applicable thereto.
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. w State License, -��' �� I Approved
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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
Seam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellarieous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets 53 1 ize of Main
Gas Piping Fees I '
Tested and Approved .. .. . . . v . .��_ -MG............................_...
D 1TE i. INSPECTOR
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