51001.2 (4) 22445 Linda Ann Cto' LOT I.O.
NO. STREET '
SRL TION FOR GAS PERMIT
1TY OF CUPERTINO
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x o V AUG 17 1 6
P'
Au ust 14
0 U Date 196 6 Permit No.
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CITYppKFti ((�DpdehokSO
the City of Cupertino fora permit to install gas pipes
o a 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
<w of Cupertino, and all other laws applicable thereto.
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Residence - Lot 16
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0 o Use of Premises
Franklin-Bahl Dev, P.00 box 911, Campbe]
3 Owner Address
_� Central Service Co. 451 Queegs Lane
J o By Address an Ose
3 ,AGENT
— 0 Phone
WW 12 7
ao State License Approved
„ PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I New 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
Floor Furnace
Miscellaneous
NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees [b
Testedand Approved .......... ........... ..... ...................._.._..........
.....
DATE. INSPECTOR