2263 In 7a LOT NO. /4 /
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No. 1''PPL�ICATIONN FOR GAS PERMIT
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CITY OF CUPERTINO
o MAY 17 9963
3 j Date 196_ Permit Na. `
=o CITY OF CUPERT"" Fee
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
> r 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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0 3 Owner
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O CONTRACTOR, AGENT
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Appro�ved—
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PLUMBING INSPECTOR
Remarks (Check ✓)
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
Miscetlane;us
(NAME, TYPE)
HOUSE GAS PIPING
Number of Outlets '1/.j Size of ¢ain
Gas,Piping Fees ,
Tested and Approved ...1...-.off. .-..(��.. ... _... ......................
DATE INSPECTOR