51027.7 (3) ao 3 7 ,;2- 1 l. l�J �^i(l V1'� LO
NO, STREET
PLICATION FOR GAS PERMIT
Z�® � CITY OF CUPERTINO
i �
` � 1SEP 20 1966
3 < Ijare 196— Permit No. 7
W LL R {¢ Fee S Sa
QTYpp�idh2fdvY:made to the City of Cupertino for a permit to install gas pipes
0 a and r ga ap I s s lrsted 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
a w of Cupertino, and all other laws applicable thereto.
ux
n Use of Premises
00
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> 3 Owner X' Address
Oa
z By S A" Address
CONTRACTOR, AGENT ✓""'"
— z Phone
uZ
o f State License �� �y Approved ' ✓�- /
a 0�U 61 WG 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)
HOUSE GAS PIPING
Number of Outlets f Size of-Main
Gas Piping Fees
Tested and Approved . ____..............
DATE INSPECTOR