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2709 jG© �f� �liaS"Ai ma Drive LOT No. f APPLIC -PI, N FOR GAS PERMIT " < 1 FEB 2 8 1964 CUPW OF CUPERTINO ` wz EX y O tt LL ¢`ITV 1 CpTi�! 02 0 ° a Dat �}. _ C196_ Permit No. 3� i Pee $ 0 ° Application is hereby made to the City of Cupertino for a permit to install gas pipes o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said'pipes 'z u) and/or appliances in accordance with the provisions of the Plumbing Code of the City a w of Cupertino, and all other laws applicable thereto. vx „� Residence Use of Premises 00 > N o a Owner Ward Crump AddressPO Rax 634 C11 rti p z_ sy Crowlav Compaa3• Address QST T _ �� ° CONTRACTOR,-AGENT 3 Mtn a Phone View n f State License l 6 � ' , Approved so rctrntetNGixsrEcroR Remarks (Check J) 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 GFiddles 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 ... ...`J ..��'`j - .... .... ....................... DATE INSPECTOR