51145 (3) 7/ LOT NO. zX
NO. ST
Fur'--y
C N FOR GAS PERMIT
IOF CUPERTINO
31 1966
Y LL `` 5 /
° Date �6 �J 1964 Permit No.-
>U CjjY OF QPERTINO Fee Ems/
° pplicatlon is ereby made to the City of Cupertino for a permit to install gas pipes
`o r and/or gas appliances as listed on the reverse side hereof, and agrees to install said pi es
> and/or appliances in accordance with the provisions of the Plumbing Code of the City
i w of Cupertino, and all other���laws
�yapplicable thereto.
4 Use of Premises
00 1 �
oa Owner 74-/ Lai Address
*-' CROWN PLUMBING dO. INC. Cp,,SWN PLUMBING CO. INC.
* z By Address802
0
3 `a SatatoBa. iI ornia Saratoga, California
- z Phone
M
0a 13oyo �
01 State License Approved
G
0
� PLUMBINC 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 PIPING
Number of Outlets Size of Main /
Gas Piping Fees -
Tested and Approved ..__._........._ ........ .............---......................
DATE INSPECTOR