2688 j/ 1 LOT NO.
NO. STREET
An' L(� OroON FOR GAS PERMIT
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OP CUPERTINO
JAN 221964 `�
3 a Date 196_ Permit No. C7
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= LL �E � Fee $ --
° aTii do s hel y a e to the City of Cupertino for a permit to install gas pipes
`o W and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i N and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all of la s applicable thereto.
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Use of Premi
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oState License Approved
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
Number of Outlets j Size of Main
Gas Piping Fees
Tested and Approved.. .1 .............
D E� INSPECTOR