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2707 ten.:„ Y //07.� LaD _Paloma rive LOT NO, o j�In, srxEeY w � OAPPL CATION FOR GAS PERMIT w Z 1 FEB 2 8 1964 f I OF CUPERTINO s '0 y LLO m 21-64 6— Permit No. Date03 — � W CITY VL 1N'4"#9 Per i LL 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 ZJ O By CONTRACTOR, AGENT• Address 855 Jackson Mtn View 3 Phone w w r 0 o State License n I Approved -U _ PLUMBIN , L 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