51145 (4)Cly /•�� �iV• LOT NO.12^'
I ON FOR GAS PERMIT
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z MpR 22 1966 OF CUPERTINO
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3 U U^' 'I 196— Permit No.TY 01- CUM 5 ��
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0 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
s a and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other laws applicable there
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LL Use of Premises —
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3 Owner Address qq S
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CON RACTO ,AGENT
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a a WILLIAM 127NEVICH
a o State Licens� 3 i3 da Approved_
o r� PLUMBING INSPECTOR /
Type of Appliance I Units Fees 11 New Replace I Relocate
Gas Ranges 1 11 1
Gas
E TYPL
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ....... .........
DATE INSPECTOR