51117 /V a,-7.0/ rlT 404 1 LOT NO.
NO. 5
® C ON FOR GAS PERMIT
W z ' MAR 2 3 OF CUPERTINO
1966 FFF����JJJ _
o
Date 7/0000'!eQ 196& Permit No.
3 a
CITY OF CUPE TINO
O Application is hereby made to the City of Cupertino for a permit to install gas pipes
`o a and/ gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i in and/or appliances in accordance with the provisions of the Plumbing Code of the City
< W of Cupertino, and all other laws applicable thereto.
u Z
w 1-
,� Use of Premises
00 /� /
O 3 Owner
Address 1017/ .C_l141'1r 66
os
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671
Jz By ('• a&/n '-Or (V) Address/25a3- �BCGPn�U1i I
0 ONTRACTOR, AGENT �-
- 0 Phone7J
W W /
a cJ�yS Approved
State cense
o�a ctie �J
o s SLi
0 r�' PLUMBING INSPECTOR
V
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
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets I Size of Main
Gas Piping Fees Ib
Testedand Approved ................... ._.r--....__..._........................_----
DATE INSPECTOR