1517 No. eeee,
A�1lq�Ij � FOR GAS PERMIT
+J+ DEC 20
196q C11�� F CUPERTINO
1-�) Date 5 Permit No.
CITY CF�uN'� 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
60 and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all o r ws app 'cable thereto.
Use of Premises
Owne' ^ _ Address
By Addres
�''Ill�lii co Acro AGENT
Phone—/7 J Approv
PLUMBING INSPECT
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9 i77
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COPY
GAS SERVIC ` O�1TICE
• BUILDING TO 'S OFFICE
CIJ
CITY OF CUPE�TINO
To _../.... ---------..._......, 196.. .
You are hereby authorized to connect th• :@ S service to
Owner or Tenant ....G..G/..�� C��/ ..._ . --- O ----...__._........_-.
At
New e 'ice ._...A........
No. of Meters _- ----...-----... Reconnect .. -.
Move Service ..... ..................
No. of Add. Meters -------------- Move Meter ..
LUMBI G INSP):CTOR
110 7/61-500