2788 NO. ® STR1'P (1,;t"k
N PL.I 1 N FOR GAS PERMIT
< tTY OF CUPERTINO
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3 < Date 196 Permit No. 02
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CITY CUPERT�1t; Feer$ 50
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o r and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i m and/or appliances in accordance with the provisions of the Plumbing Code of the City
< W of Cupertino, and all other laws applicable thereto.
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Use of Premises
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oState License a Approved
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Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
flower 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 I �V I ize of Main
Gas Piping Fees
Tested and Approved ... .I. .L.(!.�. . !.n�................................
ATE fNSPECTOR