2526LOT NO.
STREET
P�ICATION FOR GAS PERMIT
i i w CITY OF CUPERTINO
(AUG 21 1963 3 < Date 196 Permit No.
E Fee S
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
'zm and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises K DAL uff'k o
00 , —
o< Owner (A.t _n� �_ 1 rcN &U, Address_ QDmc0Q-AU
zJ �� �(t�,/� 1
Z By -PILI -k I' `1�t1 Vl1i Address Lkll ly2AYa 0
C CTOR,AGENT
3 N Phone 3�Q Q111 t
'z —1
W.
02State License tr3� 1021(D' Approv
t� I ' PLUMBING INSPECTOR
of Appliance I Units Pees
NAME.
HOUS17 GAS PIPING
Number of Outlets "?,. Size of ain I 3 I/
Gas Piping Fees 1-"O "I
Tested and Approved.........::.�..: .�. ...................
DATE INSPECTOR
To
OFFICE
COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OPPICE
CITY OF CUPERTINO
You are hereby authorized
Owner or Tenant ...........
At .... ...&---
No. of Meters ........ -------------
No. of Add. Meters --------------
110 7/61-500
1 lln�.----
the GAS/ejvice fqq
'4--C..... ....................
New Service
Reconnect ..............................