51133 //W / ��"`Y1—Ic/vC.-(�/V•/L•�'Q LOT NO.
NO.
MI � ION FOR GAS PERMIT
W i ® I OF CUPERTINO
x oMAR 2 3 1966
3
Date — '?'� 196L Permit No. �Sir`3_3
LL
CITY atCUPERTINO Fee$ / �=
O ppliction is hereby made to the City of Cupertino for a permit to install gas pipes
0 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
<m of Cupertino, and all other laws applicable thereto.
u =
~ Use of Premises
00
31
3 Owner D Address Z.
z Bj(✓1:1_e!Lyz f9'�P Address_lj 0 xi. 1a111eo
O CONTRACTOR, AGENT
3 S-
- m Phon 412 4 a o State Licensx"' s Approvedw�/
0 PLUMBING INSPECTOR
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
FE
Miscellaneous
NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ___ ......... ... ........_.._--._ .............. ........
DATE. INSPECTOR