51087 (2) 10756 Ii�d�ista Drive 13
LOT NO.
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AP LIGATION FOR GAS PERMIT
z z, �S E P 14 1965 CITY OF CUPERTINO
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W l� ( D 1965 Permit No. 0
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o 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 and/or appliances in accordance with the provisions of the Plumbing Code of the City
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of Cupertino, and all other laws applicable thereto.
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j LL Use of Premises Residence
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, 3 OwneEranklJn—Rah] CnnSY._ AddressP_0_Box 911t Campbell
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Z By Central ''CrlrJ ro f'.rl Tnc4ddres.4.51 ni,PPnS� J.
o CONTRACTOR, AGENT
3 Phone 295-0556
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a WILLIAM D. BENEVICH
°a a State Liccnae7�..5�7 Approved_
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 Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets I. 2 I Size of Main 4311-1-
Gas
//Gas Piping Fees Al 5-0 1
Tested and Approved ._................. .......---......._... ...- . ........
DATE INSPECTOR