51064 Al /`rr� for no.
No. IF
FOR GAS PERMIT
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.z ` OF CUPERTINO
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? J&QPICM7N
CT 6 1965
3 U U:rte 196— Permit No.
S/ aG �1
W LL CITY �F ChUPERTf�O Fee a /
o Applica ion is ereby ma(e o 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
> I and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all other laws applicable thereto.
Use of Premises
20
o a Ownet� Ife 4, :t;Address /go.? Z/
z
By� Address
o
�[ONTRACTOR, AGENT
— 0 PhoneJ
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aW State License ' 3 Approved
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U PLUMBING INSPECTOR /I�L
Remarks (Check ✓)
Type of Appliance Units Fees I� New Replace Relocate
Gas Ranges
\mall 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 Main
Gas Piping Fees
Tested and Approved ....
DATE INSPECTOR