51001.2 (2) 22486 Linda Ann Ct LOT NO.
NO. STREET
L Cp�TION FOR GAS PERMIT
- ` ® �j,C�tTY OF CUPERTINO
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�AUGAI17 19 6 ,�/ v C/
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° a Uatc g 1966— Permit No.
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LLC Fee S s
° C1 I Ap�tiotli R6RRkj0o the City of Cupertino for a permit to install gas pipes
o : and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
> 1- and/or appliances in accordance with the provisions of the Plumbing Code of the City
i w of Cupertino, and all other laws applicable thereto.
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Use of Premises Residence — Tot 13
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ZJ OwnerFranklinEBah1 Dev. AddressP_O_ Box 411 e rampb ell
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By Central Service Cn Address 451 Queens Lane,
F CONTRACTOR, AGENT Sqn Jose
- m Phonr 298-OSSfi
o s State License �7�539 Approvedr";'"tl""""`�""�'�-/
4 0 PLUMBING INSPECTOR
Kemarks (Check ✓)
Type of Appliance Units Fees 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 /Sp `s-
Tested and Approved ..-----..____...... ..............._...._.__......- . .....--
DATE INSPECTOR