51145 (2) "�2/' LOT No.
NO. Q ST E
N FOR GAS PERMIT
w z ®, MAR 22 1966 OF CUPERTINO
, X
2r
Y O
a LL
Date
° J c r{96— Permit No.
3 `
i U �.
CITY OF
„ Fer$
O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
r r and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all other laws applicable thereto.
w r
0 a Use of Premises
0 0 ,1
> 3 ?Address
o a
z
Z B Address
CONTAACTOR, A [.7T CA?`Js
— �
Phone
� z
o s State Licenser 3 �—1 3 u y°� Approved WIL"IANI D. IS_NIEVICH
U�� PLUMO[NC INSPECTOR
Remarks (Check d)
Type of Appliance Units Fees Ij New I Replace I 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
Testedand Approved ...... ................. ._:................-----.._.................
DATE INSPECTOR