51145 (3) V- / � O / i ✓moi',-,- LOT T0-12_/
NO. STREET
TION FOR GAS PERMIT
w d A OF CUPERTINO
wM
s
3 u l�,t .I MAY 31 1966 l96_ Permit No. to 5 �
Fee
LL0 (a licA n i E dt yRjd tj the City of Cupertino for a permit to install gas pipes
0 an �o as Ilia ¢ as is ed'on he reverse side hereof, and agrees to install said pipes
i a and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other laws aapppplicablee thereto.
Use of Premisesti-s-ct..��/
00
JOwner Address
Z g CROWN PLUMBING O. INC. pLUMBIxG CO. INC.
0 y Address p()SAN ggy
3 _ COj?IIQCI�OC ALUT Saratoga, California
- Ji Phone arato a, California
� z
a2 State License O d Approved -
-UPLUMBING 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
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Z Size of Main /
Gas Piping Fees f
Testedand Approved ..._......._._....... ........_...._....--------.................
DATE INSPECTOR