51145 LOTNO.
NO. STREET
APPLICATION FOR GAS PERMIT
z
w z` OF CUPERTINO
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0 a DI .O ., v 196 Permit No. • ����f'
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PCC'
° licp�ien ish¢ S d2t(�the City of Cupertino for a permit to install gas pipes
o ant O1O1 as h'Ppliaht�lta�-listtdd ton`the reverse side hereof, and agrees to install said pipes
> a and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all other
laws applicable thereto.
j ,� Use of Premises
00
r 3 Owner Address
z_j CROWN PLUMBING CO C. CRO PLUMBING CO. INC,
z By P O B04 802 Address
3 a Sarfi4'dd"�8hId1�PP1T Saratoga. California
— w Phone State License , u _
Approved -
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PLUMBING INSPECTOR
Remarks (Check J)
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
i
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main /
Gas Piping Fees
Tested and Approved .... ........... ....._._._............._.._..._.......---
DATE WSPECTOB