NO PERMIT NUMBER RD
LOT NO.
NO. STa T
N ® LICILFN FOR GAS PERMIT
z ` tI OF CUPERTINO
x o fJUN 2 1966 '
� 4 /
° a Date 196L, Permit No.
3U
i TF QUAD
n�(� Fee $
° C)pp icatOh is Ke�kbyh Dtd the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
is and/or appliances in accordance with the provisions of the Plumbing Code of the City
< W of Cupertino, and all other laws applicable thereto.
Use of Premises
00
.>. 3 Owner z ,T lJ)ZIZ4 c;- Address
Z J /� ' /
z By i/���Ll�zi (11AV 760 Address /'i x.39 LoohP/? �vC
CONTRACTOR, AGENT
— m Phon /
z
o IState License —6 l ` Approved_ /
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees J New I Replace I 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
r'
Number of Outlets ,-Size of Main
Gas Piping Fees .'
Tested and Approved .......:................ ...:._. ........................-,-_.._...
DATE INSPECTOR