51123LOT NO.
NO, -----STREET
®o API'AXION FOR GAS PERMIT
C I OF CUPERTINO
.1SEP 22Zsi W
Dat 196a Permit No.
CITY OF q �' �aT,R,^ Fee $ =iJ
Application is b e o� he City of Cupertino for a permit to install gas pipes
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
of Cupertino, and all other laws applicable thereto.
Use of Premises
Owner—
AddressA973,s'��yr
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z By / S'� �l///�% p Address S3 f
O C TRACTOR, AGENT
3 � _
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Phone
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Q #State LicenseAL
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Approved_
PLUMBING INSPECTOR
of Appliance I Units Fees
Heaters
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets _ ( Size of Main
Gas Piping Fees
Tested and Approved------._......_....,._:....._._._.__........_......_.......
DATE
/O " -3�rI � Cr— LOT NO.
NO,
N �FOR PLUMBING PERMIT
[TY OF CUPERTINO
W
o
?JA�Wtk,-TION
EP 22 iS5& N Sanitary No.
a /
o Uate 2 196I� Permit No, �r�/a j
3 a 0`e
CITY OF C, Pee S
� ° Application is here y ma the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
w x
w Use of PremisesUiLril�-cv� 07i'e_
00
3 Owner Address U%3.f //.1/JLf'P-P
J, B Address
J o y C NTRACTOR, AGENT
ir
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Phone
w w
a a
Q o State License. 115�?2543 Approve
—'j PLUMBING INSPECTOR v
ns
klrr
FEES
/i
Boxes
RECORD'OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final