2767 - LOT NO.'
O. Q S XE
D I jjON FOR GAS PERMIT
m a ,�APR 14 1964 OP CUPERTINO
W
Y Q J
4_8 1964 Permit No. O� 6
3 U Dads COMM
IC�
I LL Fee S
O Application is hereby made to 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
im` 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.
Wx
r
Use of Premises RES IDF.NCF.
00
3 Owner Ward Crump Addressp Box 634 Cupertino
oa
zJ 855 Jackson .Mtn VieN
z By Crowley Co Address
O CONTRACTOE,AGENT
3 <
a
u Phone
—
166998
oState License Approved r
1n-�t U PLUMHIN
J
Remarks (Check ✓)
Type of Appliance Units Fees II 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
Aliscellaneous
. NAME TYPE)
IB
HOUSE GAS PIPING
Number of Outlets I v I Size of Main
Gas Piping Fees 1/40
Tested and Approved .. ..://-.`f....�........ ................
DATE [""CTO,
6