500 Am _ LOT NO.
j! NO. STREET
APPLICATION FOR GAS PERMIT `r!
2 15 '. CITY OF CUPERTINO
r '
M c 5qJ [
Da ! *�•-' ? , ; 195_ Permit No. �pD
cd .�MAY 2 6 1959 �. . Fee a
\ Application is hereby made to the City of Cupertino for a permit to install gas pipes
I,f\ and/or as aunt{ a&. ist4�pRt�e reverse side hereof, and agrees to install said pipes
and�ria pl es Lir h the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises /li �/�/
N Owner C/� ci G;l!'� Address / G
By Address U
Its/ L. H1CKE4N�t4.A Approved
Phone In, O, 9,,. 576
C'.VVala, Calif. PLUMBING INSPEQOR�"l+
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 II
Floor Furnace I 1 II
1I
Miscellaneous � � I�
NAME TYPE) IF
I III
-
1 II
1 -111
app I�Fees 1 11 1 1
Inspected and Approved ....... ....:... ............_.._------................... ..
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets %i Size 'of Main
Gas Piping Fees
=-- f/
Tested and Approved ./m / Lard
DATE / INSPECTOR
J