2628 nt.:h.:I/-f - LOT NO.
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APPLICATjI ON FOR GAS PERMIT
NOV 8 1963 pCiTY Or CUPERTINO
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196Permit No. (J
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Application is hereby made to the City of Cupertino fora hermit to install gas pipes
o a 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
a w of Cupertino, and all other laws applicable thereto.
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Prmises
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3 Owner, ,.n Address
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By oS JY'l-G GGI�o IJO Address '
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of o State License �i5—�oZ a-- ApprovedC Z LM-GC
DC7 u PLUMBING INSPECTOR
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GAS SERVICE NOTICE orrlYe
COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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You are hereby aut on— to conned the AS se ice foie Owner or Tenant .........kC�-At t -� . /z �� - ...
�)W New Service .....�-.....
No. of Meters Reconnect
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ve rvice ......_._..._.._....
No. of Add. Meters .............. ^ v Meter
PLU INSPECT R
Ito 6/63-590