2829 /D/, `/ ` z:a- ; L .1 Z& LOT NO. ��
NO. STREET
APPLICATION FOR GAS PERMIT
ITY OF CUPERTINO
y O Q
3U D 196_ Permit No. ��O/
i LL Fee $ - S
°
Application is here b m ee�, the City of Cupertino for a permit to install gas pipes
o 1- agTYggagFplieU e the reverse side hereof, and agrees to install said pipes
> an /or app lances m accordance with the provisions of the Plumbing Code of the Cit}'
a w of Cupertino, and all th la s appl' ble thereto.
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Use of Pre ises
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3 Owner Address
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a State License ' Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
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
Steam Tables
Gravity Furnaces
Suspended.Unit _
Flo r Vurnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved. d� ...-G .....�.. .. ...._... . . . . . . .................
DAT INSPECT00.