51087 (3) i ma,7 TA
-nrin IN 8—nriire LOT No. 11
T
PATION FOR GAS PERMIT
z i CITY OF CUPERTINO
xo ® SEP I4 1965
3u Dare—$ept 196 Permit No. rl0�,7
iaU. I .f iU t Fee$ 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
> and/or appliances in accordance with the provisions of the Plumbing Code of the Gty
of Cupertino, and all other laws a
< ) P' applicable thereto.
u I
Use of Premises Residence
0 3 owner Franklin-Bahl Const. AddresP.O.Box 911, Campbell
o <
J z By Central Service Co. Inc. Addres451 0 to .ns T.nnp S_J.
0 CONTRACTOR, AGENT
3 Phon 29$-0556
� z
1 State License Approved WILLIAM D. DENS`./I/'•-f j
PLUMBING INSPECTOR ✓
AL
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 Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main /,-
Gas Piping Fees 1•S
Tested and Approved ........................ ...:............._.._...... ..................
DATE. INSPECTOR