51145 (2) �j✓ �J "�//// /.JN LOT NO.
7
NO.
m I ON FOR GAS PERMIT
z i ® OF CUPERTINO
Y o ,MAR 2 2 1966
0 :1
< Date 196— Permit No.
wu CI1Y �F CUPERT�lVO
x LL Fee8 .$
° pplica ion is here y ma a 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
r i- and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all other laws applicable thereto.
W x
Use of Premises
o_ o
1 N
3 Owne Address
oa
z B ` Address
° CON RA;!OR GENT
1 ; aW — G
m Phon
u 2
a State Licensed — 23 OXO Approve'WILLIAM D. CENEVICH
_ o PLUMBING 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