51037 il � (Do �Fl 24242
NO. STREET
y �. PPLICAT���ION FOR GAS PERMIT
a ® QITY'OF CUPERTINO
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3U Date (JAN 18 1965 146— Permit No I -o- 17
w Per$ I
p�YatflpFis 11]]'�re�1y m � i�e City of Cupertino for n permit to install s pipes
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and gas app1iance7 as'lis"ted one reverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
n of Cupertino, and ther laws applicable ereto. I
0 a Use of Premises
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State License Approv &A;f't
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PLUMBING INSPE
Remarks (Check V)
.Type of Appliance Units Fees II 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
Floor Furnace
Miscellaneous
�(NAME TYPE)
t
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ........... ..................._.......................
DATE INSPECTOR