51145 GAS 1 1,
2 % tc 1 . LOT NO.
NO. STREET
I FOR GAS PERMIT
i TwR
CUPERTINO
xLL 22 1966
3 u Uate _ Permit No.
=
CITY
' 0 p FerS
o ApplicationQC h& �PLR'TJNGity of Cupertino for a permit to install gas pipes
'o and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
r and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all er laws ' able thereto.
u t
w �
., Use of Premises
o_ o
1 N
0 3 Owner Address
iJ D
o By Address
CONTRALTO . AGENT
3 N Phone
u Z
oState License D Approved
_U PLUMBING INSPECTOR 21
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
Stearn Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets I Al Size of Main
Gas Piping Fees I
Tested and Approved ..........._._....._.I ------._...............................
DATE INSPECTOR