2805 7 IC LOT NO.
APPLIC QN FOR GAS PERMIT
m z ff'�APR 2 7 1964 OF CUPERTINO
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° � Dat ` � '^'f196'� Permit No.
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1n Fee $
° 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
r and/or appliances in accordance with the provisions of the Plumbing Code of the City
Q w of Cupertino, and all other laws applicable
thereto.
4 Use of Premises
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oState License ��So29 Approved
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-0 PLUMBING INSPECTOR
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Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Bimer Furnaces
Chas Fired Boilers
Warming Ovens
Percolators
Griddles
Stcam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Ndmber of Outlets Size of Main
Gas Piping Fees ,
Tested and Approved .. ....lP- ....... .......... .....
DATE INSPECTOR