51037 11127 Linda Vista Drive 169
LOT NO.
NO. STREET
APPLICATION FOR GAS PERMIT
r z CITY OF CUPERTINO
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F 0 S
3 u DateUNT 196— Permit No.�
_ LL Fee•E
7 1964
0 Application is hereby made to the City of Cupertino for'a permit to install gas pipes
Oa and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
t . 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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S r Use of Premises _
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"; Owner Ward Crump AddresspO Box 634 Cupertino
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z By CROWLEY CO AddressS55 Jackson Mt View
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3r CONTRACPOR, AGENT
— 0 Phone. YO 7-5579
u2
o f State Licens Approved
< O PLUMBING INSPECTOR
—U
Remarks (Check d)
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 P PING /
Number of Outlets IV / I Size of Main
Gas Piping Fees
Tested and Approved ........... ......... ...... ...................
DATE INSPECTOR