2418 LOT NO.
NO. �STIlEET�� .
n APPLICATION IFOR GAS PERMIT
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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
a w of Cupertino, and all other laws applicable thereto.
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Use of Premises
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Address
CONTAACEOR,AGENT
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'I PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
JBlower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
, NAME TYPE)
HOUSE GAS PIPING
Number of Outlets I I Size of MSin
Gas Piping Fees
Tested and Approved .. .. .. :f. .. .. ..... -..............................
.. DAT / INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ------------------------------------
GAS
....... .....GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
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1 S.
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24.
' 25.
118 1/63-500