51145 (�/7f/ /./Ji� LOT NO.
NO. STREET
W m APP��LrIC 'TION FOR GAS PERMIT
a ® �I OP CUPERTINO
w2 {U
s
S11Yy3 . 1966
3 < Date f r11 tt � 196 Permit No.
w w C' hakclp[pTIN(1 Fers__ltSa
I o (? jif{caty Is fSyln} to`t�e City of Cupertino for a permit to install gas pipes
o a and r gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other ws applicable thereto.
W = �
o_ o Use of Premises
> N
3 Owner Address
i z B CROWN PLUMBING CO. II Add eesOW PLUMBING CO. INC.
J O y I
o R ,tiGENT O. Box 802
3 < Saratoga, alilornia Sarato
— N Phone ga. California
w z
oState License 3 �� Approved
U 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 3�. Size of Main
Gas Piping Fees
Testedand Approved .............. ......... ...................__.__....................
DATE INSPECTOR