803,O / ai/i� P �`� • � LOT NO.
BET
'. PPLICATION FOR GAS PERMIT
• -iTY OF CUPERTINO
.Date �••+• "70,
195_ Permit No. • �3
Fee $
p 'Application iseheeIreby Mohe City of`Cupertino for a permit to install gas pipes
dnnd�/or as 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 GuperEin^o, and all other laws applicable thereto.
Use of Premises
't
n Own
By A A Address
CO AC OR, A ENT iI
Phone j Approved y�I��IaM D. BENEvICH
PLUMBING INSPECTOR
of Aonliance I Units Fees
Gas
Miscellaneous
(NAME TYPE)
Inspected and Approved .............. :............................ .....................
.
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets j Size of Main
Mas Piping Fee— s e,
Tested and Approved . i 1. .... - --
DATE INSPECTOR
GAS SERVICE NOTICE a`r.. �,y OFFICE:
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO .;.�.
To x
,•,
You are hereby authorized to connect the GAS service for
%
Owner or Tenant ...�.('�l(g'!i(/:: ..
S�`Nui
l2�`r�lP�fi
0,—
At '
/ New Service
No. of Meters ..... ............... Reconnect
Move Service-..:...
No. of Add. Meters .............. Move Meter ..........................
Imo..
PLUMBING INSPECTOR
110 6/59-500
5-�,.