51087 (4) 2 oMas<ista Place LOT NO. 22
1 HE T
AP ' CATION FOR GAS PERMIT
p a (SEP 14 1965 CITY OF CUPERTINO
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3UCI1PYe M- Eft-LIFURTM 1965 Permit No. .J 1'0 ,L7
Pers 1. 50
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
'o m 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 City
<w of Cupertino, and all other laws applicable thereto.
u x
Use of Premises ResJdenrP
03 Ownepranklin-Bshl Const. Address
P'O.Box 911, Campbell
oa
By Central Service Co. Inc. Addre,,451 Queens Lane , S.J.
CONTRACTOR, AGENT
3 G
- W Phone-2-UA-05 56
WW 171537
M1 a WILLIAM D. R P:?VICH
a° tate License Approved_
PLU\fRl\, 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
Stearn Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets • ,a Size of Main
Gas Piping Fees /•�CJ�
Testedand Approved _.... .........._.----i._:........._...._.___.._...............
DATE. INSPECTOR