51087 (2) 2 m i ista Place 20
LOT NO.
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BSEP 14 1g6P �ICATION FOR GAS PERMIT
a CITY OF CUPERTINO
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3 a1/I lire epu•���P�TM--_ 1965 Permit No. i� � ��
w Fee$ 1.50
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
'o r 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.
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0 Use of Premises Residence
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a Owner Franklin-Bahl Const. AddressP•O.Box 911, Campbell
?Z By Central Service Co. Inc. Address451 Queens Lane, S.J.
CONTRACTOR, AGENT
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Ph...298-0556 _
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a o State License Approved WILLIAM D. 6ENEVICH
PLUMBING INSPECTOR
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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 .Z Size of Main
Gas Piping Fees V s
Tested and Approved ...._....---.__.....,....._.........._._..._......_.........--
DATE INSPECTOR