863 (2) /07761 z°� z&.1 .
•LOT NO.
STREET 7"•
APPLICATIOK FOR GAS PERMIT
CUERTINO
Date DEC ,Ty59' 181959.
195_ Permit No.
CITY OF CUPERTINO Fee s-��-
Application is hereby 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.
x •
Use of Premises ./LC-d�-r
65 Owner��Iil�tvrn. c-r-c-e> Address y
By nivisiom1I Address
HEAfiMn&'1§r,E' N",TAL '0
1 Approved WILLIAM D. BENEVi H
Phone I-� +w� oc r—Pa CAI
n t ? PLUMBING INSPEQrOR
Ar Remarks (Check ✓1
Type of Appliance A I Units Fees 11 New Replace Relocate
Gas Ranges
Wall Heaters I r f
Gas Plates' • ' '�,',y'�
Circtrlgting Heaters
•Blower-Furnaces
Gas Fired Boilers lII
Warming Ovens
'Percolators
" Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace _
Miscellaneous i� "'•
(NAME TYPE) III
77-pp lance Fees /• o
Inspected and Approved��. .!.. �...... '... .-- .
ATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Ga�Piping,Fees
Tested and Approved .....'.................. ...................................... .......
DATE INSPECTOR '
T
GAS SERVICE NOTIQE r �-TICE,
BUILDING INSPECTOR'S'OFTTCE , j tv
t `�'• CITY OF CUPERTINO <'
fP .
To
You are hereby authprized to connect the GAS rvice for
Owneror Tenant --........ ..... . ---------------------------------- .......... ..•i..
.. New.Service .... ...............
No. of Meters .../... ........... Reconnect .............................
Move Service ........................
No. of Add. Meters .............. Move Meter ..........................
PLUMBING INSPECTOR -
nn 6/59-500 ,,. j