51064 NO. STREET
n APM)CALLION FOR GAS PERMIT
z ` ?(OCThTT, OF CUPERTINO
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0 LL 5 1965
° a Uare 196_ Permit No.
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W W � ��p�pTIn'/� Fee $
° �Tp`icaG is ryYJ4rSP7LI4' NOle City of Cupertino for a permit to install gas pipes
'o i and or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
,. 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
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3 Owner//' SO 13' 'ZFJe / Address -1d �Z <
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J ° t.ONTRACTOR, AGBNT
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- 0 Phone
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m State Licensed f -3 - Approved
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 1000,47 L41
Tested and Approved...................
DATE INSPECTOR