51104 ,,2, o3(, / far l/L,C�CiC� LOT NO. /,7
NO. 3 T
PT 1 N FOR G
W Z AS PERMIT
n i ® C F CUPERTINO
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3MAR26 1965 Permit No.
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Date ( 6_
= 'o rn� Fee•$ Z Sv
ORIF hl RT4NQCity of Cupertino for'a permit to install gas pipes
'o and/or gas applfiances as listed on the reverse side hereof, and agrees to install said pipes
'za and/or appliances in accordance with the provisions of the Plumbing Code of the City
I( W of Cupertino, and all other laws applicable thereto.
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Use of Premises .
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m '//t-o�-n.E.e� Ly .4 n/ Address 9
0 3 Owner �'' // nn /
z z By &e Kly AA—st/ 1=e a�, Address -1/4–/
F CONTRACTOR, AGENT
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State Licens 7 / .67,3Approved
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t O LAUMBING INSPECTOR
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Remarks (Check ✓)
Type of Appliance Units Fees 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
Miscellaneous
(NAME. TYPE)
flil
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees 4M
Testedand Approved _.._.._.............. ._:...._._........._..._....:.............
DATE INSPECTOR