51145 (3) LOT NO,
® APPLIBION FOR GAS PERMIT
< f MAR 2 2 1966 OF CUPERTINO
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3 :1< LTV f1C f41DLpT= 1q6— Permit No.
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O Application is hereby made to the City of Cupertino for a permit to install gas pipes
p and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i w and/or appliances in accordance with the provisions of the Plumbing Code of the City
. W of Cupertino, and all other laws applicable thereto.
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00 Use of Premises S.��Cr/.� •�
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CONTRACT , AGE96
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°ao State License-3G -•�3o m Approved WILLIAM D BE ME r"H
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Remarks (Check ✓)
Type of Appliance Units Fees I� New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boi!ers
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 INSPECTOR