51145 (3) LOT NO,
NO. ST I',�IJ�,/
® N FOR GAS PERMIT
p a OF CUPERTINO
o MAR 2 2 1966
Q LL
3 a Daten196_ Permit No.
? LL (�,I py OF. NPERT11, 10 Fee
o pp cahon is hereby made'to the City of Cupertino for a permit to install gas pipes
$ < and/or gas appliances as listed 'On the reverse side hereof, and agrees to install said pipes
s 1- and/or appliances in accordance with the provisions of the Plumbing Code of the City
U)
of Cupertino, and all other laws applicable thereto.
u =
w r
0 LL Use of Premises
00
3 Owner Address
ZJ
z B Address d
O CONTAACTO , AGENT
C
0 Phone
RM1 L �G3Gi<o NILLIAM D. B-NF_`IICH
a l State License Approved_
_ � 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
Stearn 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