862 (2) 1/790 LOT NO.
_} NO._ C. STREET
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
yDate DlE��i'H I959G 195_ ' Permit No.
DEC 181959 Fees_/
Q 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 appliance in�accordance 'with'tlie provisions of the Plumbing Code of the City
7 of Cupertino, and all other laws applicable thereto.
I � `
Use of Premises
�n Owner Zk' •> Address
By ! Address
HEAfiVT ''MC'Etv`7vUAL CO. / ApprovedWILLIAM D. nFrjEUIru
Phonegggr." NNYSUAKS AVE.. _.._T"" CAI .
PLUMBING INSPECTOR
c.'ryRearks (Ch dc ✓) -
Type of Appliance Units _'Fees Im
New Replace Relocate
Gas angesWall Heaters I• -l� ��
Gas Plates I I'AL Jill
Circ4ting Heaters
Blower Furnaces
Gas 'fired Boilers ;�Ir`-
Warming Ovens
Percolators
Griddles
St am Tibles� I .(I / Imo• !�
Otavity Furnaces I II .{ (,.'r I� ! I
Suspended Unit I , ;I-J .W j`'
Floor Furnace
Miscellaneous I I itlow
(NAME TYPO
pp lance Fees I
Inspected and Approved ,LO. ....L .. .....�f._.. ................
ATP. INSPECTOR
,'r HOUSE GAS PIPING
Number of Outlets I I'.-;Size of Main I —
Gas Piping Fees I {:
Tested and Approved .............:..:...:.:I......................................... ..
DATE -Y INSPECTOR
~ GAS SERVICEN "�� ICE OFFICF
• BUILDING INSPECTOR' •FICEt :=
CITY OF CUPERTI
645
P............................I 19
To
o'
You are.hereby auth 'zed to connect the GASIstwice for
Owner.or;Tenant --- .... ...
nr; -' .... .. ... .............. ... .
New Service Y.............
No. of Meters .... ................ .Reconnect
Mode Service -----------------------
No. of Add. Meters .............. Move Meter ........................,.
PLUMBING INSPECTOR :�
110 6/59.500