2792 LOT NO.
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SPP I OR GAS PERMIT
i ® APR 171964 ,� O' 'U iRTINO
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O a D19f Permit No.
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'- o Application is hereby made to the City of Cupertino for a permit to install gas pipes
`o a 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
a w of Cupertino, and all other laws applicable thereto.
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00 Use of Pres
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n Y State License. 3 Approved
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U 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
Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of fain /
Gas Piping Fees
Tested and Approved ...... . ...
DATE INSPECTOR