51087 (2) 10711a IJ nrin Vi sta nri up LOT NO,
NO. T ET
AM L TION FOR GAS PERMIT
` ® I, OF CUPERTINO
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W '0 ISE P 1.4 1965
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3 a Uate Sept. 13 1965— Permit No. L ,7
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W CIT1� QF . CUPQTIf�O Pee $
O pp QF is ere y ma a 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
> a and/or appliances in accordance with the provisions of the Plumbing Code of the City
wof Cupertino, and all other laws applicable thereto.
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W Use of Premises
Residence
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Owner Franklin—Rahl f',nnci-. _ AddresP;,fl Rny ;Ill, Clamphell
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antr;;l Sarina ('.n _ Tnr, Addresl51 Qnaana TAne 4 _ J,
34 CONTRACTOR, AGENT
— m Phone. 299-0556
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WW
M a171537 Approved WILLIAM D. 6ENEVICH
°a o �to License
U PLUMBING INSPECTOR
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Remarks (Check ✓)
Type of Appliance Units Fees I� New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boi!ers
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
Tested and Approved .....---- .. _......_i._..................._._......- --......----
DATE INSPECTOR