2652 NO. TREFT .
N A,LICA,TION FOR GAS PERMIT
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� (CITY OF CUPLRTINO
DEC 16 3 C
Y G 'j
3 a Date 196 Permit No. "" 3
o CITY OF CIIPFRT' Pee $ 9
Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
r r and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all of rr la s ap licable thereto /
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LL Use of Premises
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Address
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0 CON CTOR, AGENT
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State License � �'Z- Z�� Approve
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n, —U 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 _
Moor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping F s a0
Tested and pproved ........ :� .........._...... ............
INSPECTOR