2293 jG✓ •J y..I J_ (CAS!_ _Ln �� ~`LOT NO. v.
NO. �tt`"STREFT\ '
APPL'ICATION FOR GAS PERMIT
z a (' CITflCir CUPERTINO
x o =`� '[VI AY 2 1953 t
LL
o a Date -5�/+°� 1963 Permit No. . 94'3 _
3 U C'_�/ In
. T 1 CF t PERT I.. Pee $ ';r-0
iLL
o - Application is hereby made to the City of Cupertino for a permit to install-ggas.pipes
`o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i
in and/or appliances in accordance with-the provisions of the Plumbing Code of the City ,
< w of Cupertino, and all other laws applicable thereto.
< o Use of P ises
3 Owne Address
zJ
z B, Address
3 <
N ACTOR,AGENT
m Zhe r7 � _/Zo icense d7 `3�J I Approve
D. BENEVICH
< o !
—U
i PLUMBING INSPECTOR'
Remarks (Check ✓)
Type of Appliance Units Fees I 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 _
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets 1 .2� Size of Main
Gas_Piping Fees ' -�1 �
Tested and Approved-lr"L..z..-._.f ---..J '. . ._..._................
DATE / INSPECTOR