51132 �o S 3 0 �o �i A� /� ✓ �. LOT N°.
NO, TREY
N ®AP,IIVD TION FOR GAS PERMIT
CI*NOF CUPERTINO
z
W ¢ NOV
Y
° 22 1966
LL /� �// 3 L
° a Date ` V 1965 Permit No.,
3 —°
LL° TcV.se � KTIOb ^
+th,atieCity of Cupertino for a permit to install gas pipes
o J� anl/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
,. d/or appliances in accordance with the provisions of the Plumbing Code of the City
zCupertino, and all other laws applicable thereto.
0e of Premises ��� M N[,� � C 100 L
a, Ownerb,i `�rtr A t.A Address 1 O(�S 30 PO (L\,4 L
o
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_10 �L�� tri (/ �oQ Address ��) � LrL�iyh [kl
Y
F NTRACTOA, AGENT
— m P n O 7
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State Licens'E 3o 3 Approved
¢ a
a 00 PL OINC INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I� 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