2782 • D L� LOT NO. 7 /
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L LION FOR GAS PERMIT
` Ii Y OF CUPERTINO
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° < Date 19fi Permit No. v
w LL C OF UPERT -Y. Fee $_ 5 0
° 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
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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0 o Use of Premises
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O CONTRACTOR, AGENT
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s State Licens 7S Approved
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—0 PLUMBING INSPECTOR
Remarks (Check ✓)
t Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
•Blower Furnaces
Gas Fired Boilers
Warming.Ovens
'Percolators
Griddles
Stearn Tables
_C�,ravity Furnaces
Suspended Unit
Floor Furnace
1
Miscellaneous
NAME TYPE)
HOUSE GAS PIPI
Number of Outlets o it Size of ain 3 �i
Gas Piping Fees
Tested and Approved ....... . . .. .\ .. ... .•ue............................
O P. INSPECTOR