2703D J� e0`/l/F ✓'" ' . LOT NO.�
NSTREET
A�PIPLIICAThQN FOR GAS PERMIT
FEB 2 8 1964 �� - OF CUPERTINO
Dater' • i 1 U 196? Permit No. 763
Per$/— —_
Application is hereby made to the City of Cupertino for a 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 all other laws applicable thereto.
Use of Premises
Owner
By--/—,
CONTRACTOR, AGENT
Phone ✓'2'�%%�• ✓ 3J.�
State License
'L 5
4
A/ C
ApproveGf
c
PLUMBING INSPECTOR
of Appliance I Units Fees
Heaters
(NAME TYPE
ft
HOUSE GAS
Tested and Approved...._.l.T�..7....4<1..�......................