51157///l'�6 //- dsl�f!✓/9Ctir i// OT NO.
NO. 5 F. FT
ION FOR GAS PERMIT
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OF CUPERTINO
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3 U U[a�teT nF r' I�i INn 196_ Permit No.
W 0 C'IY Q P' tRo Fee E�
° pylic on 1 e the City of Cupertino for a permit to install gas pipes
'o r and/or 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
w of Cupertino, and all other ws applicable thereto.
00
se of Premises l
3
OwneE Address-
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z BrGy, / rfi %J7 i /fir r Address 390 p
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CONTRACTOR, AGENT
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a a Z ' ~CCC30 WIL-LIAM D. HENMCH
a° o State License Approved_
PLUMBING INSPECTOR
__
of Appliance I Units Fees
NAME
HOUSE GAS PIPING
Number of Outlets , I Size of Main
Gas Piping Fees 1141
Testedand Approved ................ ..........................._..........................
DATE. INSPECTOR