2759 LOT NO.
NO. STREET
APPLICATION FOR GAS PERMIT
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Jaz CITY OF CUPERTINO
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o 2— 196� Permit No.
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m LL Fee $_
_ ° pp w die to the City of Cupertino for a permit to install gas pipes
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o Aa��Ur gppW tstl'eidl on the reverse side hereof, and agrees to install said pipes
r and/or appliances in accordance with the provisions of the Plumbing Code of the City
z(1) of Cupertino, and all other laws applicable thereto.
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0o Use of Premises
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J ° CONTRACTOR, AGENT LiV 2/Sv v �a
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— < Phone L S 2-3 6- ✓
oState License 3 Approved
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PLUMBING INSPECTOR
Remarks (Check J)
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)
HOUSE GAS PIPING
umber of Outlets Size of Main
Gas Piping Fees
ested and Approved -.:. O /
DATE. INSPECTOR