653 a
�CGSO I Lt ry/U SP/ / ' LOT NO.
NO. STREET„•
IA•~P,PLIION,LFOR GAS PERMIT
Low,,
,
CITY ,)CUPERTINO
�JUL24
Date f 2 2 1959 195_ Permit No. .�^_
/. .'
CITY OF CUPERTINO Pee $--�
\ Application is hereby made to the City of Cupertino for a permit to install gas pipes'-'**
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
of Cupertino,,and all other laws applicable thereto.
U ,
Use of Premises+
n Owner ' Address
sy�I Address
Pho 497 kwens�r' �d°PSanvE�7ara Ce Approved
PL NG INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I NewI ReplaceI Relocate
Gas Ranges I I I IA"a`
Wall Heaters
•Gas Plates I II I
.. Circulating Heaters I II
Blower Furnaces I' / Sc` II ✓ I I
Gas Fired Boilers
Warming Ovens I I I
Percolators" R I
Griddles,.
Steam"Tables I II
Gravity,Furnaces
Suspended Unit
Floor Furnace I I I _�
I I II t
-Miscellaneous I iI 1
'(NAME TYPE)
I I II I I'
-tip
I I II I I
p lance Fees S�—
Inspected and Approved ...................
DATF. INs"c,
HOUSE GAS PIPING
Number of Outlets I I Size 'of Main
Gas•Piping Fees ,
_1
t'Tested'and Approved ........................I................................... .;.........
,{, DATE INSPECTOR
GAS SERVICE NO_TI E', OFFICE '
BUILDING INSPECTOR'S OFF fE,% '' COPY -.
,+ CITY OF CUPERTINO '� •`i `:.
a.
To ey J
You are hereby author' ed to conn eAhe GAS"service;for',•,' 1',".i•`'
Owner or Tenant .. . .... ........
..... ....-i
Atre ...... ...........................
/ate . .:..................... . ......:.
New Service -- ----.....: .:...
No. of Meters ---1................. .t !?,4.4ggconnect .............
Move Service ....: ...........
No. of Add. Meters .....: Move Meter.. .........:........
..
/.;
PLUMBING INSPECTOR
110 6/59.500All, �'