51145 (3) LOT NO.,4-
NO, TRE
® I N FOR GAS PERMIT
Z ?rMAR 22 OF CUPFRTINO
o1966
R j S pi s
°
3: 4 Uatc 196— Permit No.
WU CITY OF �U�E, �I(�( Fee S S
° Application is ere y e e 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
r and/or appliances in accordance with the provisions of the Plumbing Code of the City
in
of Cupertino, and all other laws a plicable thereto.
Use of Premises
00
3 Owner - Address
, G
z By Address
° CONTRACTOR, GENT
3 0 Phone C _.
� z
a WILLIAM D. B -!`2�2vICH
a0 State License G'l 3 o' Approved_
0 PLUMBING INSPECTOR _ /
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)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ......._......-- . .....................- ......................
DATE INSPECTOR