1301 C) Q ( Cy PR L S �._{J r LOT NO.
® P TION FOR GAS PERMIT
APR 10 19ITY OF CUPERTINO
Date_ 3'6 1901 Permit No.
CITY OF CUPERTINOFee $
y� Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
�n and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other flaws applicable thereto.
Use of Premises -7
Owner Address _._
By -�11
CONTRACTOR, AGENT- � � Address r
Phone�tiL7— 3 U77 j Approve L
r i PLUMBING INSPaCTOa /
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GAS SERVICE INGTICE OFFICE
-I;Opy
BUILDING INSPECTOWS FFICr
CITY OF CUPERT11
. . ....
.. ................... 1961.
....... ................
Q. .. f...--ZTo- I -
You are hereby auth to connect the GAS service_for
Owner or Te .. ..... . ........ .....* .....**.........
At .. ............. .......... ..........................
New Service ...i!f!:�................
No. of Meters .. .........7.......:.... Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. Move Meter ..........................
.... .......................... ..........
LUMBING INSPECTOR
lio 1/6o-m