2223 - GAS PERMITas
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9�( o 11 I � , LOT NO. -
NO. STREET
3;;7kA PPLICATION FOR PERMIT
® CITY OF CUPERTINO
l APR 16 1963 a
Date `T n �- (�� I D �jT 196— Permit No.
Wxiacid s�.ht��b�MaH� It r` Fee• it
lic n i e to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the -City
of Cupertino, and allSZ:
s a ble thereto..
Use of Premises �"atsk
Owner
By
CONTRACTOR, AGENT
Phone
State License
Address / 0 –23 -7 5 CAA'i�
Address
Approved c - RF
PLUMBING INSPECT -PR
J
of Appliance I Units Fees II New
Gas
Circulating Heaters I I II I I
Furnaces
nit
(NAME TYPE)
-_I_-
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees it
Tested and Approved .. ... . .. . ........................
DATE INSPECTOR