51145 GAS azdaI.O Nn � �
NO. TREET
o �Q N FOR GAS PERMIT
?MA
OF CUPERTINO
0
R 22 1966
3UUate , 196_ Permit No.
w �r11 n �p In (� Fee $ 42
0 pwcatUis UbDyfiii3dT`tti Qe City 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
i m 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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� r
Use of Premises
00
3 Owner - Address
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z ByAddress �—
0 CONTRACT , AGENT , '
3 m Phone
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0 tState Licens�3�'Z3e�aJ ApprovedWIT I IAM D Rcatr:ulry
_U PLUMBING INSPECTOR
1
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