2733 raa�2—lJ COO- I V tom[ +moo LbT No.
NO. THEE
A N FOR GAS PERMIT
w EMIAR
CF CUPERTINO
1 o 5 1964 iii q�' q��q����
o < Date 196— Per
No.
3�
° �� QF ��1FERTIf��O Fees
I tIo s he e y ma e to the City of Cupertino for a permit o install gas pipes
o 6- 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
<w of Cupertino, and all other laws applicable thereto.
w t
r t-
.. Use of Premises
_oo
1 N
0 3 fNnei• v - Ad ress
Z J &I O
o t13y Address
wi hone �Jpt�77 ' 7�4' _
":State License a!/Q .?O I Approved
0
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees 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)
5 2
HOUSE GAS PIPING
• Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ._ - ..�1...J:'t/ ........ . ...................
TE \ � INSPECT00.
Multi-House Gas Inspection Card
Gas Permit No. ....................-------------
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
1.
2.
3..
4.
5.
6.
� B
9.
10..
il.
12. '
13--
T4-
16.
31416.
17.
18.
19.
20.
;21.
22.
23.
25.
118 1/63.500