864 /0762 ko--� &w : pQ „.:.
LOT NO. O " : . t�•.
STREET
/^i'
r 'I) (APPLICATION FOR GAS PERMIT
CITY &P &PERTINO
Date DEC 1 6 1959 195_ Permit No. i-
iY CF CUPERTINO Fees ,'=:5D
Q Application is hereby made to the City of Cupertino.for a permit tainstall gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes ,
C and/or appliances in accordance with the provisions of the Plumbing Code;of the City
of Cupertino, and all other laws applicable thereto.
v
i s
Use of Premises
a, �p
Owner!-CC tM f--w� Address
By DIVISION Address
HEA'H4dS"Y.TR!Ei'9WLML CO A roved WILLIAM D. BENEVICH
Phonetsn F cunNYn RC qVr ' . CA PP
PLUMBING INSPECTOR
�;.1 Remarks (Check ✓)
Type of.Appliance I Units--'Fees II New Replace Relocate
Gas Ranges - 'I I I< II
` Wall Heaters
Gas Plates
Circuliting Heaters
Blower Furnaces J.S-0
Gas Fired Boilefs
Warming Ovens i
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit 1 p
Floor Furnace
Miscellaneous
(NAME TYPE
pp iance,, ees -S 0
Inspected and Approve v .'av) Lam_.....................
.::p ATE / INSPECTOR
HOUSE,GAS PIPING',,*-.,:
Number of Outlets, 'Size of Main —
Gas Piping;Fees i t
Tested and Approved .. ................... .......:....................................
DATE INSPECTOR
y h rr'
rr� JGAS SERVICE,-NOTIE OFFICE
BUILDING INSPECTOR'S OF C
CITY OF CUPERTINO n "
.... .. ............+r `1.:. r....z........, t9l�d
you are hereby au/ttj�/' i�ze��d to connect the GYle rvice'for oc�
,-.Owner or,Tenant ..S -------------:----- .'7!1 ... ...:...:.'..............::�:{•.
"'•' "'''" New Service '
No. of Meters ....
Reconnect .
Move Service
No. of Add. Meters ----------- Move Meter .......................... .
-
' ` r PLUMBING INSPECTOR
it 110 6/59-500 '