51145 LOT NO.
NO. STREET
APPtI ATION FOR GAS PERMIT
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w ` ® OF CUPERTINO
0OI0 �} 1QQy/y�� 91966
1JV�3U Permit No. .Jr��T2
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)Tff lic0Fn iCe�y�t�d�Othe City of Cupertino for a perFeemit toinstall gas pipes
0 r an flor gas appliances as listed on the reverse side hereof, and agrees to install said pipes
iand/or appliances in accordance with the provisions of the Plumbing Code of the City
Ln
a w of Cupertino, and all other laws applicable thereto.
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w Use of Premises .
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o <Owner Address
z B CROWN PLUMBING C . IkrGI Addre
J o y 4'RO N PLUMBING CO. INC.
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- < Phone Saratoga. California Saratoga California
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f State License 7 D� Approved
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Remarks (Check d)
Type of Appliance Units Fees II 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