51123 (2) tgO/O-+ Z d!!�' LOT NO
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APPLICATION FOR GAS PERMIT
a.
z IhTIY
OF CUPERTINO
JAN 24 1966
o a Uatr 196— Permit No. ��`�3
3 LL �I �F CUPERTINfI Fee
o P I cati n 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.
u Z
w r
0 LL Use of Premises
00 '
3 Owner 62 5r, ,Address
2J
z By C%Lrif70il Address
CONTRACTOR,?NT
3a`
— m Phone
ao State License Approved
-U LUMBING iC
Remarks (Check J)
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
Testedand Approved _..._.._.._....._,. __.__...._......._.._._...----.._---
DATE INSPECTOR