2704 O or�s3 �✓� X�r• LOT NO. /✓
?/FEB281964
APPLICATION FOR GAS PERMIT
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O < Date 'a 196-#"/
96 Permit No. c2 d
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O Application is hereby 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
<w of Cupertino, and all other laws applicable thereto.
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CONTRACTOR, AGENT
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State License 6 S q;' Approved Za
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U PLUMBING INSPECTOR
Remarks (Check V)
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
'(NAME. TYPE
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HOUSE GAS PIPING
Number of Outlets Size of Main J
Gas Piping Fees
Tested and Approved .... ..'�f..�.'.. /�. . . ...............•..
DATE INSPECTOR