852 (2) LOT NO.
NO. STREET
APP ICtATyION FOR GAS PERMIT
Da!? / ' OF CUPERTINO
1 i jr�.4 Date t� �`o 4 c+? A 95 "195_ Permit No. 6
n r pp''{{ N
Fee $
Aplplicahon is hereb�yktt5'adelfd�he 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.
c
Use of Premises ✓t c-iz�
„ u
l OwnerZICZ,U-V� 46:n�- Address
By DIVISION fa
Address
HEATdW6r$n4914EET+IW%L 00 WILLIAM D. SENEVIC14
Phone180 E. SUNNYOAKS AVE., CAMPBELL, Approved
f PLUMBING INSPECTOR l
e
Remarks (Check ✓)
Type of Appliar ce;t,I'Tbruts Fees II New Replace Relocate_
Gas Ranges
Wall Heaters :�: •:a:: ?+'
Gas„Plates ;W
Circulating Heaters �'tx
Blower Furnaces -4w I ,j iSd
Gas Fired Boilers
Warming Ovens i I�
Percolators_.� -
Griddles
Steam Tables
Gravity, urnaces t a
3uspen ed Unit
Floor Furnace
Miscellaneous I
FEW
(NAME TYPE),
II - 1
I I II —T-1
II -
pp lance Fees .�'0 II'
Inspected and Approved .. �.G .!. _..
DATE INSPECTOR
HOUSE GAS PIPING
Number of OutletsF Size of Main
GasPiping Feei j
'Tested and Approved ............. .......... .........:.......:............................
DATE �� MSPECTOR
:GAS SERVICEiA TICE z + -OFFICE
BUILDING INSPECT 5 FICC a� _ cOPti, .
CITY OF CUPER `
'
' 19If'/0
To
f You are hereby autho 'zed to conned,the GAS' r"; .for:"
(
ill Owner or Tenant --- "...... ......._.
/ .. .. —
' New Service
No. of Meters .... .................. Reconnect
.............
Move.Service ...........:............:..
I
No. of Add. Meters .............. 'o ' Move Meter ..........................
---------- .. .....---...................
LUMBING INSPECTOR_
110 6/59.500