51145 LOT NO.---( (/
NO. STREET
APRUCATION FOR GAS PERMIT
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Y OP CUPLRTINO
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° ¢ pat 'MAY 31 1 196— Permit No.
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FeeS_ —
° pli , n fl �'q the City of Cupertino for a Permit to install gas pipes
o W andl br�gas! plii<Tic1e Mat d1��l,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
a w of Cupertino, and all other laws applicable thereto.
0 o Use of Premises D
Z: O Address
j G C INC CROWN UMBING CO. INC.
i By P. O. Box 8 Address
J ° 07a(*MjL -Q 7%A' 6NT Ox
3 < SorOtago. California
— m Phone
io State License , /�/ I Approved f�
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py' PLUMBING INSPECTOR
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