51064 CIL
t0 r LOT NO.
N EE
® 1 FOR GAS PERMIT
CI F CUPERTINO
Y o , MAR 18 1966
3 U Date 196 Permit No. 's
w LL UPERTINO Fee$
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
=m and/or appliances in accordance with the provisions of the Plumbing Code of the City
4 w of Cupertino, and all other laws applicable tthhee?yetto.
ao Use of Premises //
3 Own '0�
o <
ZJ
J z By / Addres,
3 C NTRACTOR, AGENT ,"'
— m Phone'- � 7C
� z
o f State License AW � Approved
ao
U PL MBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I� 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)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved .......... ........:........._.....----..................-
DATE n4SPECTOR