51087 (3) Vista Place LOT NO.117
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AI PLICATION FOR GAS PERMIT
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ISEP 14 1965 CITY OF CUPLRTINO
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3QI IYatee11UPERTINO 196L Permit No. 'SAO d'
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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
i 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.
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Use of Premises Rpai denee
20
W .01 Franklin Bahl Const. Address •Oj Box 911, Campbell 11
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; = By (:antral Service Co.
Inc-Address-CONTRACTOR, AGENT
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o i Mate License—1-71 7l S i1 _ Approved WILLIAAA D. DENEViC-r
< o ,1.. PLUMBING INSPECTOR
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
Tested and Approved ..............__.._.. ...._....._.........------....__..----
-DATE INSPECTOR