100042 (3) LOT NO.
NO�® LI ION FOR GAS PERMIT
J U L 9 1965 OF CUPERTINO
D , 196 f Permit No. /0 C)
CII
Fee $
Application is hereby made to the City of Cupertino for a permit to install gas pipes
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.
of Cupertino, and all other laws applicable thereto.
c
Use of Premises
u (/
in Owner Address
By Address
f
I
CONTRACTOR, AGENT�none 7L3G Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees New Replace Relocate
Gas Ranges
Wall Heaters II I
Gas Plates
Circulating Heaters
Blower Furnaces I I I
Gas Fired Boilers
Warming Ovens
Percolators I I I
Griddles
Steam Tables I
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
I I II - I I
I I II I I
I I II I I
II I
Appliance Fees ] I I
Inspected and Approved ..............:...I.
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Size of Main
Gas Piping Fees .SZ
—� —
Tested and Approved ..... ..................I..............................-- ..............
DATE INSPECTOR