654 (2) 4-7 O&U, L
iCc� _ NO.
NO. STREET
/APPL CATION' FOR GAS PERMIT
`� �CITY60F CUPERTINO
JUL2"_ lsa9 C!, 5
Date J ll L 2 2 1959 , 195_ Permit No.
CITY 0,11; CUPERTINO Pee s i
Application,Whereby 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.
c
Use of Premises
' u
�n Owner Address
B DIVISION Address
�74D7 Slovens ree R . �enla Clan, CaM. Approved
Phone _ PLU BING INSPECTOR
Remarks (Check d) .
Type of Appliance I Units Fees II New I Replace Relocate
'Gas Ranges
,Wall Heaters
Gas
If Circulating Heaters
Blower Furnaces • 11 /-4e IL I' I
Gas Fired Boilers I I- . 11)
Warming Ovens I Ii�-
Percolators _ ,-,/ I �I
Griddles. '
Steam Tables
Gravity Furnaces
Suspended Unit I I
Floor Furnace
I . l
;Miscellaneous '
V (,,NAME TYPE
PP Iahce Fees I I' •S ��
inspected and -Approved . .. .........................
DATE INSPECTOR
—
HOUSE GAS4PIPING
N_ ,jini er of'Outlets, IAF I , Size of Mam
Pipinffees I•;+,
..46ied and;TApproved ................_'...I. ......
...................... .............
's ' *Jf. 4 DATE INSPECTOR
^'� '."" ' GAS'•SERVICE N FICr 9 '°oPYE
v BUILDING INSPECTOR+ T.i-11
,.
ITx�,OP CUPERTITI�� � � � •
You arheieby auto iiQ WEauined-theiGAS service, r. v01
1,4440
Ow' , it enant ....
. •
.-- •"� --- -------.------.......... ........
At ..l.f.!f!�- ..- ... ..-- ..
... ..... .....:...........................
.;t
..- •. "'' • '\ New Serice
No. of Meters .... ............... Reconnect ..............................
Move Service ........................ '
No. of Add. Meters .............. Move Meter ..........................
----.-----------INSPECTOR.................--------
.. .
PLUMBING
110 6/59-500 "