51132 (2) NO. STREET
PfLI,C TION FOR GAS PERMIT
OF CUPERTINO
W �
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3 V Date 2 1966 96� Permit No.�o .3 L
17
O (1j� ca is�J �� e City of Cupertino for a permit to install gas pipes
`o and g s a lances as a e on t e reverse side hereof, and agrees to install said pipes '
i a and/or appliances in accordance with the provisions of the Plumbing Code of the City
W of Cupertino, and all other laws applicable thereto.
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W Use of Premises
00
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3 3: Owner Address 0 S`$ a 490gµ,(
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z Byqv Address
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CONTRACTOR, AGENT
N
Phone
WW /' e
0 U State License d Approved(
\/ PLUMBING 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 I I Size of Main
Gas Piping Fees /
Tested and Approved ........ ................_ .................
DATE INSPECTOR