51037 11117 Linda Vista Drive LOT No. 170
NO. STREET
APPLICATION FOR GAS PERMIT
i z CITY OF CUPERTINO
M ° OCT 7 19&4 / 61
3 < Date 196— Permit No.
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O Application is hereby made to the City of Cupertino fora permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
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U) 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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J LL Use of Premises
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3 Owner Ward Crump AddressPOBox 634 Cupertino
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azo By CROWLEY CO Address R55 .Tnpkenn ►Tt yiAty
F CONTRACTOR,AGENT
— W Phone XO 7_"S78
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State Licens 4 y Approved
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—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 PIING
Number of Outlets ! Size of Main
Gas Piping Fees
Tested and Approved _..._..____....... ...... ......
......................
DATE TNSPr.CTOR