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w � OAPPL CATION FOR GAS PERMIT
w Z 1 FEB 2 8 1964 f I OF CUPERTINO
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21-64 6— Permit No.
Date03 —
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W CITY VL 1N'4"#9
Per i
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O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o Wand/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
aw of Cupertino, and all other laws applicable thereto.
w I
j LL Use of Premises Residence
00
3 Owner Ward Crump Address PO Box 634 Cu ertino
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O By CONTRACTOR, AGENT• Address 855 Jackson Mtn View
3
Phone
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0 o State License n I Approved
-U _ PLUMBIN
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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 I
Miscellaneous
(NAME, TYPE)
HOUSE GAS PIPING
'Number of Outlets Size of Main
Gas Piping Fees 1 .
Tested and Approved .!7/010.41...... . ....................................
DATE INSPECTOR