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„ ✓� �AP?LICATION FOR GAS PERMIT
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° a Date — 26 Permit No.
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° 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
im and/or appliances in accordance with the provisions of the Plumbing Code oftthe City
a w of Cupertino, and all other laws applicable thereto.
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° - CONTRACTOR, AGENT
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i,o �t State License G�L• Approved
-YI PLUMBING INSPECTOR
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GAS SERVICE NOTICEI °orYL
BUILDING INSPECTOR'S OFFICE
��11lYYY CITY O'JPCUPI RTINO 'a
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To
You are hereby ,iut orized to conned the GAS"
Ov:ner or Tenant .:!.��':W.. .. C7C�C�. ..... _''!.--�........-
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At ...................
Service
New ./-- ..............
•. 111111
No. oEJMeters•.....:.. ....:..:.... Reconnect ....................... ......
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Move Serve
{ No. of A&Metetsj.!............ v r ...................._.....
o ete
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PLUmIB4 INSP' T R
110 6/63500