51117 9 LOT NO.
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APP I _ TION FOR GAS PERMIT
w Z I SEP 24 1965 -CITY OF CUPERTINO
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196_
C{TPermit No.
196—
W Fee $
0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
o Wand/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
=N 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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OCONTRACIOR, AGENT
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ao to License �+'�� — ApprovedV///
-0 P RING INSPE T
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates _
Circulating Heaters
Blower Furnaces
Gas Fired Boi!ers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE. GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Testedand Approved ............. .......... ._._..._._....._...___.................
DATE INSPECTOR