51145 (3) LOT T•O.�CSL_.Z
NO. LT
N `P I ITY ION FOR GAS PERMIT
w OF CUPERTINO
x o MAY 3l. 1966
0 i Date 4 3 / ,966 Permit No.
LL CITY OF CYPf�UldNQ Fee S�
0 Applica ion is ere y made 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 m and/or appliances in accordance with the provisions of the Plumbing Code of the City
m of Cupertino, and all other laws applicable thereto.
u = '
Use of Premises Hlilri
00
3 Owner Address
o z By—CROWN PLUMBING CO NC. Address WN PLUMBING CO. INC.
J o ox
Saratoga, a�ifC
— 0 PhoneS atoga: California
State cense 3� y07 Approved
- /
� z
a Y
a
o
LiAd
-U� PLUTfBISC 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 Size of Main
Gas Piping Fees
Tested and Approved ....... ........ ...........:.._.................._...__.........._.
DATE. INSPECTOR