51145 (3) 3
LOT NO.
NO. �1
ON FOR GAS PERMIT
z i ® OF CUPERTINO
f MAR 22 1966
F O _
Y
0 ,
J Date 196— Permit No.
a 1 (�F �+ n T nI
3LL Yb I�UfERI �IV� Fee8.,`'SL
o �)Nica I n is ereby 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 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.
u =
w f
a Use of Premises
00 d
o < Owner Address
z 0
z By Address
O CONTRACT A, AGENT
o F State License C3 G'-2-3df�o7 ApprovedWILL1AM D.
a 1 PLUMBING INSPECTOR
i
Remarks (Check d)
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. INSPECTOR