51145 �rs�a LOT NO.��
NO. REET
SLI TION FOR GAS PERMIT
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z i ® �j OF CUPERTINO
F
KIWI
U1) APR 4 1966 , 196_ Permit No.
-
° Qvffliea fon C� KhWothe City of Cupertino for a permit to install gas pipes
'o an r 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.
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a Use of Premises
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3 Owner Address
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J ° CONTRAC , AGENT
3 w Phon
ao State License —7 D Approved (/
+ M NG 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 _.---............ ....i........................._.._.:__.....----
DATE INSPECTOR