51087 (3) 10717 Li�n�d•�a• Vista Drive LOT NO. 3 _
NO ..a.l STREET
TION FOR GAS PERMIT
(�V® ITY OF CUPERTINO
BSEP 14 1965
3 o Date Sept. 13 , 5 J2.0 .�7
a 196— Permit No.
U
W 0 CITY � Fee S 1.50
° Ap catiP �l �s h to the City of Cupertino for a permit to install gas pipes
'o 1- 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,
u x
0 o Use of Premises — Qsj d-ence
Oa Owner rLr8rik1 J n-Bahl Const. Addres'P.Q.Pox 911, Campbell
z� By rent.ral Service Co. Inc. Addres451 Queens Lane S.J.
° CONTRACrOR, AGENT
30
— m Phone298-0556
WILLIAM D. Com:NEVICH
Qtate License 1 1 Approved_
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New I 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 ;Z I Size of Main �y
Gas Piping Fees /,SC1
Tested and Approved ...................._..,.__. ...............__......_.... .. ....
DATE INSPECTOR