600 ' S LOT NO. � c
NO. STREET�+ A
� 4 AP.PL•ICATIOI F AS PERMIT
d CTTY;OF. C ` RTINO
�. 1^OJul 1 1959 f�
Date 7 195_ / Permit No.
t'tTY O� Gl,'PERTINO Fee
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.
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4
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Use of Premises/
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A T- Address
'�'�' fiCONTAACTOA AGENT A
;Phone. _ APProv
PVTJMBING INSPECTOR
h
t� Remarks (Check J)
Type of Appliance I Units Fees II New I Replace I Relocate
Eas Ranges
V/all Heaters II I I
Gas Plates I I II I
Circulating Heaters I I (-
Blower Furnaces I I II I
Gas Fired Boilers I 1 II I
Warming Ovens I 11 I
Percolators I I I
Griddles 1 1
Steam Tables I 1 II I I
Gravity Furnaces
Suspended Unit
Floor Furnace
I II
Miscellaneous
( AME TYPE) I I I
I I II I I
II II II II I
I I II
pp lance Fees —��—�—�—
Inspected and Approved ..... ..... .... ............ -----
DATP. INSPECTOR
HOUSE GAS PIPING
Number of Outlets 1 Size of Main
'•'Gas Piping Fees I• p
Tested and Approved ./. ..... ...................:...............
DATE INSPECTOR __
GAS"S,VkVICE NOTICE OFFICE
I -P• :.'COPY
r' BUILNINSPHCTOR'S OFFICE `
?.
t TC�OP.CUPERTINOs
�:
-------..
x/..19 .................... 9.
To
You are hereby authorised to corinect.the GAS service for r-,, -.•
Owner or Tenant .. . .. .... ..... .. . ......... -
/�/ . ......... ...... ................
At .. LC.(O.7Y....+ .. . .---. �.FL..DIS ..•............._----..................�
New Service ....'
No. of Metets .... ...... - ---. Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. ~ Move Meter ..........................
-- .... ............ ............
PLUMBING INSPECTOR
110 6/59-500 .