51087 (2) 2 LOT NO. 23
TR
AP KATION FOR GAS PERMIT
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. I S E P 14 1965 W : CITY OF CUPERTINO
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3 ���(te (1FSPF�P�'!�,Ifl1965 Permit No. ��-Q 7
Fee $ 1.50
° Application is hereby made 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
> r and/or appliances in accordance with the provisions of the Plumbing Code of the City
i w of Cupertino, and all other laws applicable thereto.
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Use of Premises RaSi dPnra
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5 a Owner Frc-m klin-Bahl AddressP•O.Box 911, Campbell
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j = By Central Service Co. Inc.Addres451 OnPPns Tana ,S. J.
° CONTRACTOR, AGENT
Phone298-0556
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a o 171537 Approved WILLIAM D. L =N"VICH
State License
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees Ij New ( Replace I 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 �/. q a
Tested and Approved ............ _......... ..................__..........._......------
DATE INSPECTOR