51087 1 LOT NO. _
NO. STRE
(SEP
z l. 4 19e9PP OF
ICATION FOR GAS PERMIT
a CITY OF CUPERTINO
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w � ,
I O
o < CITY s@�t�li.�ERTINO
3 Dae 1965 Permit No. ��
wJ Fee$ 1. 50
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O Application is hereby made to 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
=m and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
u i
a Use of Premises
Residence
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Owner$ranklin-Bahl Const Address P_0_Rox 911 Cell
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W
w w WILLIAM D. BENEVICH
State License 17153 Approved_
a O PLUMING INSPECTOR
l
Remarks (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 [3 u t
Gas Piping Fees /Z .
Tested and Approved ........................
DATE INSPECTOR