1809 LOT NO. /a .
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MET-
NO. S,, _ .,
® ON FOR GAS PERMIT
JUN 20 1962 OF CUPERTINO
Date 19&--1-- Permit No.
CI OF CU Fee s
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.
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Use of Premises 3 !ate i Z d",
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W Owner < O Address _
By Z., Address z /
CONIAACIO ,:Z AGENT �
Phone Approv
PLUMWNG INSPE
Remarks (Check J)
Type of Appliance I Units Fees II New I Replace Relocate
Gas Ranges I I I I
Wall Heaters
Gas Plates
Circulating Heaters I II I
Blower Furnaces �_I II I
Gas Fired Boilers
Warming Ovens
Pettolators •I
Griddles i Ik II I
Steam Tables I I I
Gravity Furnaces
Suspended Unit
Floor Furnace
I I II I
Miseellcneous I it I
(NAME TYPE)
I I II I
I_
pp lance Fees —
Inspected and Approved .............. ...............................................
DATP INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Size of m
Gas Piping Fees
�J
Tested and Approved . .. 7 . i
ATE INSPECTOR