801 ------ GOT NO. •+?.eL
.X O• • IF TRE T
1 .A FOR GAS PERMIT
A F CI d OF CUPERTINO
r 22 9
�:• -. -Date , .195_ Permit No. _
CUPERTINO Fees_
_�. :`-t"tlpplication is he 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.
v
c i
Use of Premises
a '
o
n
Own e f
d fess
By Address
co COR, AG Nr aIVILLIAM D. BENEVICH
"hone Approve 1
PLUMBING INSPECTOR
Remafk IMEeck ✓) .
Type of Appliance I Units Fees II New Replace I Relo ;te
Gas Ranges
Wall Heaters
Gas Plates I II I
Circulating Heaters
Blower Furnaces I'
Gas Fired Boilers I I II 1
Warming Ovens 1 II I I
Percolators II
Griddles I I II 1
Steam Tables I I II I I
Gravity Furnaces 1 I II I I
Suspended Unit
Floor Furnace II I
I 1 II I
Miscellaneous
I I .I I
NAME TYPO I I II
I I II I I
II II 11I II i —
I
pp lance Fees I I
Inspected and Approved ..... .. _..:._!_...._...................._..................
DATE INSPECTOR
HOUSE GAS PIPING ,
Number.of Outlets I I Size of .Main
Gas Piping Fees I pl
Tested and ApprovedI.. .
DATE // INSPECTOR