51087 (3) 10737 Linda Vista nri y LOT NO. 5
NO. STREET
B ATION FOR GAS PERMIT
OF CUPERTINO
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3U196 Permit No.
w LLFee 8 1.50
O C.TYApRiFrr atiQji R€r� to the City of Cupertino for a permit to install gas pipes
o` and/or gas appliances as liste�on the reverse side hereof, and agrees to install said pipes
r r and/or appliances in accordancewiththe provisions of the Plumbing Code of the City
'<w of Cupertino, and all other laws applicable thereto.
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use of Premises Residence
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of OwnerFranklin—Bahl Cnnst_ Addres!,n_Bnx eller f�hell
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z By f:dnt.ral SPryi re Cn Tnc,Addres4.51 Queensa
T. ne. , S, J.
o CONTRACTOR, AGENT
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— Phone 298—.05.5.6
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0 a Stale License Approved WILLIAM D. e=?-"�'VlCH
` 0 PLUMBING INSPECTOR
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Remarks (Check ✓)
Type of Appliance Units Fees New I Replace I Relocate
Gas Ranges
Will 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 •-;2_ Size of Main 1 ,31V
Gas Piping Fees li.Sp
Tested and Approved . .......... ........... ...:...._.................. ._._.......
....
DATE. INSPECTOR