51145 (2) 7 r 2- /_�`il..«.. 'bre'ez'ej 6w LOT NO.
NO. STREET
-A►PP ION FOR GAS PERMIT
`— {� �� C OF CUPERTINO
' 0
(Y
3 Date 3 1966 A6� Permit No.s�
U
Fee'E
o is Cit of Cupertino fora permit to install gas pipes
o a Pp � L "tPevese side hereof, and agrees to install said is
i m and/or appliances in accordance with the provisions of the Plumbing Code of the City
a W of Cupertino, and all other laws plicable thereto.
r �
20 Use of Premises e
> 0 _
3 Owner Address
Z 1 13 CROWN PLUMBING O. INC. AddresCRO N PLUMBING CO. INC.
y1R. Box 882
3 4 Phone Saratoga, California Saratoga, Cabiomia
W
of State License Approved
ao
-0 �). PLUMBING INSPECTOR' /
1 V
Remarks (Check J)
Type ofAppliance 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)
HOUSE GAS PIPING -
Number of Outlets j Size of Main
Gas Piping Fees
Testedand Approved .._........._.._._.. ......_.. ............ ....................
DATE INSPECTOR