51145 (2) LOT NO.
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® ST '. C N FOR GAS PERMIT
Z AR 22 1966 OF CUPERTINO
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° aUn 196_ Permit No.
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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 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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3 Owner Address
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RR State License�3��Zjcl '�'° 7 Approved V'!ILLIAM D. CEN—VICH j
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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 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 ._.....................t....._..._.......... . .. ...................
DATE INSPECTOR