51087 (3) 221 1 Mcr1A11 ,qn mad LOT NO,
NO. STREET
SIC ION FOR GAS PERMIT
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® �i1' OF CUPERTINO
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BSEP 14 19
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3 a Uate Spp1• "l 196 Permit No. � 7
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Peri 1-50
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' 0 UT'Ylicio(� isGeJRK tRTeltlohe City of Cupertino for a permit to install gas pipes
01- and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
> 1- and/or appliances in accordance with the provisions of the Plumbing Code of the City
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of Cupertino, and all other laws applicable thereto.
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Use of Premises Resi deriCP
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Q a Owner Franklin-Bahl Cnnc+ AddressP.O.Rox ql 1_ (T.nmrh_11
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Jz By Central Service Co. Inc.Addresd,51 Qiiepra Lane,rS J.
° CON/TRACTOR, AGENT
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aW W WILLIAM D. BENEVICH
a State License 171537 Approved_
_U ,I PLUat6INc INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees �I 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 . _ I Size of Main 3w '
Gas Piping Fees I tSU
Tested and Approved .......... .............._...........
DATE INSPECTOR