51087 (3) f07 p Vista Drive LOT NO,ISA PSL CATION FOR GAS PERMIT
EP 14 1965 CITY OF CUPERTINO
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314IT ata E 4. .8 1965- Permit N0. ��d �/
WFee$ 1. 50
Application is hereby made to the 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
'z m 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.
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QaOwner Frank in—B hl Conqt,. AddlesF�..O.Box 911) Sampbt'l1
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CONTRACTOR, AGENT
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aState License 171 Approved WILLIAM D. P rmr—i—t
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0 �� PLUMBING INSPECTOR /
Kemarks (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 ^Z, Size of Main �y
Gas Piping Fees
Tested and Approved ..............................................._-----...............
DATE INSPECTOR