867 a \�
LOT NO.
'• NOS' x; STREET
-PPLICATION FOR GAS PERMIT
a CITY OF CUPERT NO� Q�
Date DEC 16 1959 1195_ PX
4a� 1p�
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14-JA Fee S11160,
Application is hereby made to the City of ?p?I'rVnoe r a ffitL ti j.;4,laas pipes
and/or gas appliances as listed on the reverse side3ihereoflvrand agrees too mstatl 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.
e
Use of Premises �e c
05 ' L72D's'"`if�in.-e.L,4l n--> Address_.
v? Owner
By Address
HEA15MTVcSWt'r4r 'ML CO. Approved WILLIAM 1). BENEVI .H
Phone PP
'.• ) ; PLUMBING INSPECTOR
A
Remarks (Check J)
Type of Appliance its Fees II New Replace Relocate'
. .Gas itanges :'.':CS•'�i'� �` ��
••••\v/sll
Heaters'�fl�
Gast',^lates,,;
Circula g_eaters li
,dower -or es
Gas Fir Boiler
` Warmin - Ovens
Percolarois
\Griddles
Steam Tables
Gravity Furnaces -r
Suspended
Floor Furnace
'... I I JI
" "Miscellaneous _ l I ' iI
NAME TYPE)•p, ' I I II
------------
I I I I I
I I I
pp lance Fees I / o II
Inspected and Approved 1a0..
�• ATFINSPECTOR
HOUSE GAS PIPING
Number of Outlets I I Size of Main
Gas Piping Fees
Tesidand Approved ........................I...............................................
DATE INSPECTOR
� �y, • GAS,,:SE VI 6 NOTICE +� :°opY�
BUILDING• SPECTORS OFFICE
1lJ ' ;-EITYO CUPERT INO'
zv
To
You are hereby iut_orti6d t ect,the GAS service for
/ v- -�,4�,� .,n�
r or
ant
At Owner-Q enlT.. IY-G.K' ,�'G ;(..._... ..a.......
......._........._ :-X}• +�
fi..
::. New Service ...............::-.....:.. "•'
No. of Meters .... ................ - Reconnect ..........it:...... •'
Move Service .......................: :.
No. of Add. Meters 'Move110 6/59-500 Meter ..........................
PLUMBING-INSPEC>TOR _T - .