1868 t 6•�g M �Rr, II WUz� LOT NO. I1
NO. STREET
® `PPL O qppp' OR GAS PERMIT
+JUN 21196' W�UPERTINo
Date--k/ --Y t , 1956 Z Permit No. ( go
CITY OF CUPERTINO Fee : C� 00
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 F,S 16 G N C 5—
Owner
Owner i3 i'1( 111 4,9 r t n/ Address
By s r tJ C R 4)iM 8)A/G Address / - i �
CONTRACTOR, AGENr `
Phone L' ;;L/90$, TApproved_
PLUMBING INSPECTO
f
d > o
-- ------ ---
y ` 'J
GAS SERVICE NOTICE OFFICE
BUILDING INSPECTOR'S OFFICE
CITY. OF CUPERTINO
/ I ......... 19
.... ...... ........... ...— ...........
To You are hereby auth lZed to friect th,( AS service for`
Owner or Tc ..........._...._.._.. .....1.
............... ......
At ..— -_....J i
...
... ............... ---------
New Service ..........................
No. of Meters Reconnect .... .........................
Move Service ........--............
No. of Add. Meters ........
...... � Mb Meter ......................./
PLUMBING
I lo 6/63-5(H)