51087 (3) 2 D LOT NO.2_
U. TR E
APL ATION FOR GAS PERMIT
zZ
BSEP 1. 4 1965 CITY OF CUPERTINO
F R
Y 0
LL
3YUCITSx o f 7
te PERT! _, 196 Permit No.
W Fee $ 1. 50
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a 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
U)
of Cupertino, and all other laws applicable thereto.
u =
w h
0 n Use of Premises R.Bsdderiee
00
> 3 OwneFranklin-Bahl Const. AddressP•O.Box 911, Campbell
oa
ZJ
; = By rPntral SPrv; r.e Co. Inc. Addres451 Queens Lane , S.J.
O
o CONTRACTOR, AGENT
3
— m Phone 298-0556 _
W
a Z State License171537 Approved WILLIAM D. BENEVICH
- 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
(NAMF TYPE)
HOUSE GAS PIPING
Number of Outlets 1 7- 1 Size of Main
Gas Piping Fees /r_1!ol
Tested and Approved ................... ....r---------...................................
DATE INSPECTOR