2732/U 7_ ✓ �' LOT NO._
NO. JM ����
rV
FOR GAS PERMIT
CI P CUPLRTINO
NAR 4' 1964_
Date 7 196 � Permit No. J�
CITY OF CUPERTINO Pees 3
Application is hereby made to the City of Cupertino for a permit to install gas L)ipes
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 Cit}'
of Cupertino, and all other laws applicable thereto.
Use of Premises
CONTRACPOR,AGENT
Phones ' z 3 3
State License X S Approve '
PLUMEING INSPECTOR
of Aooliance I Units Fees
Gas
NAME
Heaters
HOUSE GAS PIPING
Number of Outlets
02 Size of Main
Gas Piping Fees
—70 /.�.. .... ..........................
Tested and Approved
DATE INSPECTOR