51087 (3) 10757 Linda Vista Drive LOT NO.
yjO. & EET
t{ATION FOR GAS PERMIT
pw ` ® CITY OF CUPERTINO
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° S FSP 14 195
Y ° ,I�/ O � 7
3 U U:¢c ePt• 196 5 Permit No.
QLIPERTY Fees 1. 50
° CITY
A�- icat d y e 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
> a and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all other laws applicable thereto.
" � Residence
j ,. Use of Premises
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OwnerFanLl in_Rahl f on4t AddressP Q. $OX 911.E Campbell
J, By Central Service Co. Inc. Address451 Queens Lane , S.J.
° CONTRACfOIL AGENT
3 `m Phone 2g8-0556
u Z
o State License 171 Approved WILLIAM D. DENEVICH /
�' // PLUMBING INSPECTOR /
Remarks (Check ✓)
Type of Appliance Units Fees I� 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 Ell
HOUSE GAS PIPING
Number of Outlets A I Size of Main PAK
Gas Piping Fees ,-5-ejI
Tested and Approved ._._..._......._ ...... <....................._......_._.......
DATE INSPECTOR