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FOR GAS PERMIT
CUPERTINO
JUN 23 1965 �_ s //s_7
Uare Permit No.
Fee S 7 -
A{( i. aYon,P, er@l�lKRTt lj(if'.ity of Cupertino for a permit to install
and/or s a plt nces as l e on t ereverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of th lumbing Code of the City
of Cupertino, and all fer laws applicable)herelto. - n
Use of
CONTRACpTOR, AG
Phone�.S — d 7 �XT
State Licen'
Address �p
Address���11 4i
Approved (/
PLU.IRINC, INSPECTOR
Type of Appliance Units Fees �� New Replace Relocate
Gas Ranges
NAME
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ---- _...................- - .._.._........_...
DATE INSPECTOR