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51037 (3) ?/,wG.. �No. U. � S RE �r P 1 lON FOR GAS PERMIT z ` ® I OF CUPERTINO Zz ISEP 2 0 1965 w � f 0 0R �j o. S/ 3 196_ Permit N i LL1 1 V fUU1 L.I%TMFee $ '� �d o 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 i w 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 I w 0 o Use of Premises > N 3 Owner �� /Civ�� Address///. coc� cy/k 0 < � z Al�/���-z��•L Address-5r 0 �RACTOR, AGENT AGENT 30 - w Phone W ww 0U V State License/ J � 3 Approved - / PLUMBING INSPECTOR 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 �5�1 Tested and Approved _...._.............._ ...... DATE INSPECTOR