1300 LOT NO.
®'APR �ibP� ►T FOR GAG PERMIT
CII F CUPERTINO
Date Ci7'l y Q`C—AW�R�p� 1 IKO�j Permit No.
p Fee $
Application is hereby made to the City of Cupertino for a permit to install gas pipes
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
of Cupertino, and all other laws applicable thereto.
Use of Premises s
uyq
r7i Owner Address
By Address =490
A �(
i11 CONTRACTOR, AGENT
Phone ON 7-7 Z/7% Approv
1 PLUMBING INSPECTOR
2 / /[2
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GAS SERVICE NOTICE OFFICE
COPY
BUILDING INSPECTOR'S OFFICE
_• CITY OF CUPERT
V ....e...7..-.............................. 196./.
To
You are hereby aut�ized to connect the GAS rvice for
Owner or Tenant ... �.... iQ1:C>..... ..... . ----!��t1....
7./
..........................
New Service ....... '..
No. of Meters ...... ...... Reconnect ..............................
Move Service ........................
No. of Add, Meters .............. Move Meter ..........................
...................
PLUMBING INSPECTOR
110 1/60-300