866`p /Q 3 o 4 Iw`-'c -"' ti iL('ilJ LOT NO.
STRHHT -
APPLICATION FOR GAS PERMIT
-OF CUPERTINO
i�
6 1�
.� Date DEC�_ � ?�19 ��Q •` i95_ Permit No. �—
Fee $_ ' '5—z7
Application is.herebyjmadelto tFiekCity of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
24C
Use of Premises
u /n ��p � � � �
in
Own er✓�WVU'D��-JxQe— Address o
By nivisinN1 Address
HEATR,TVc$Hf'EfG1Ett4AL CD. ApprovedwrLUAm o BENEVICH
Phone a vc Au r
PLUMBING HIPPHCTOR
• " -' ' " Remarks (Check d) .'
Type of Appliance' •I Units Fees II New Replace Relocate
Gas, Ranges
Gas'glates -- ', 1 II
gryaters
1
Circulatin I
' Blower Fu : a s / /.S O II
✓
,GascFired_Nflpilers .
/\UQing , ens
-Percolators %,
Griddles\, '1
Steam Tables
Gravity Furnaces'
-
'Suspended „Unit
Floor Fui ace l
II
II
�
II
Miscellaneous
�' •.'`�
d(NAME TYPE)
r
pce Fees /. So
\ Inspected and Approved'.....�.litlQ.;.�.
I ATE ! IMPECTOE. Y'•-"
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Testedand Approved ...................................................................
DATE INSPECTOR
GAS SERVICE NOTICES
^ �+ BUILDING INSPECTOR'S OFFICE
CITY Oh CUPERTIN- -- -,
��
To.. y
-'� You are hereby authorized to connect the GASservrce for
Owner or Tenant ... ........ .... At
_ �_/.'.-..-.�..0�------ . ..................f
No. of Meters -..-,1 .................
No. of Add. Meters "---:
110 6/59 -So :', -•„�
OFFICE
19-P.
New Service---L.:r...............
Reconnect
Move Service .......................
Move Meter ..................
PLUMBING INSPECTOR