903 (2) LOT NO. V R/
�.:. p NA• STREET
Rj r' EA1PFL TION FORrGAS PERMIT
t� Y& OF CUPERTINO
tJAPJ 20 1960
Date ,.195_ Permit No. D�
CITY C; CUPERTINO . Fee $ / 5!
Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed Ion 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.
i v
Use of Premises--/ /' •!�' '
v
Ii Owner r1h- AQZ& Address
By Address
CONTRACTOR, A .NT
Phone Approved WILLIAM D. BENEVICH
PLUMBING INSPECTOR
Y
Remarks (Check ✓) '
Typopf Appliance Units Fees [Ne-w- 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 II _
Flout Furnace
'Miscellaneousi-
NAME TYPO
Appliance Fees
Inspected and Approved . .........:...'............._............... ..............
DATE INSPECTOR
HOUSE GAS PIPING
Mumber of Outlets Size of Main
Gas Piping Fees
'
— —
Testerand Approved ... .?.y/�d--.�._ .. .. ...... .._..................
TATE INSPECTOR