51087 (2) 10767 da Vista Drive LOT NO.�__
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P ATION FOR GAS PERMIT
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14 1965 CITY OF CUPERTINO
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¢ 4 / off 7
e_{�� 196-5 Permit No.
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w SCI 1 Uf Fee $ 1. 50
° 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
r r and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all other laws applicable thereto.
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J 4 Use of Premises Residence
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OwneErankl i n—Bahl Const- AddressP_0_Box 911 f armbe�;
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° CONTRACTOR, AGP.Nr
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Phone 299-0556
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n i 171537 Approved
° WILLIAM D. BENEVICH
a e License
U PLUMBING INSPECTOR
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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 FurnacesF,
Suspended Unit
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets • 2 Size of Main ��YAK
Gas Piping Fees I, a V r
Tested and Approved . ................
DATE INSPECTOR