2367 LOT No._ l0�
Jm ei�T � A
ri"UIR
' 711 1(CCA1 ION FOR GAS PERMIT
2 0 1963 OF CUPERTINO
s0
3U Date ' q Ur/ Vu C M` 6.'L Permit No.
x o Fee $
F Application is hereby-made to the City of Cupertino for a permit to install gas pipes
oa and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i a and/or appliances-in accordance with the provisions of the Plumbing Code of the City
w of Cupertino, and all othei-laws applicable thereto.
v. Use of Premises !
00
D .,[ i moo„
i o a Owner m DA'I Address
zJ
o By 9ZZWL� Addiess ��rD2
< Phone
w-m,:` :.• •r :•= - WILLIAM D. BENEVICH'; ••
01 'S+fate'Lieense-Z36-"• a`j Approved
R
Remarks (Check V
Type of Appliance Units Fees II New Replace Relocate I
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators A
Grid les _ +
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE
. j.
r
HOUSE GAS PIPING
Number of Outlets 2 Size ofMain "f
Gas Piping Fees
...... .- :.J.. .t ..1..,..:......_.._.........`..
Tested and Approved ;f,.._.,.(
DATE INSPECTOR'. :.
GAS SERVICE NOTICE OFFICE
COPY
ILDING INSPECTOR'S OFFICE
CITY OF CUPERTt7__
................................... ... ....................... I9
To You are hereby author a to connect the GAS ice for
Owner or Tenant ....................... ........ .............
At ....................( ........ .... ... ...............
New Servi
No. of Meters ....I................ Reconnect,•................................
Move Service ........................
No. of Add. Meters .............. mo �Meter ..... ........
. .... ....... . ........
PL BIN INSPECTOR
Ito 6/63-506 0