2282 2 / zz 21-1'2,-.—/,-.— LOT NO.
NO. STREET
APPLICATION FOR GAS PERMIT
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3� Datc r 196`3 Permit No.
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Application is hereby made to the City of Cupertino fora permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
iand/or appliances in accordance with the provisions of the Plumbing Code of the City
It)a w of Cupertino, and all other laws applicable thereto.
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i Owncr Address
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ddress CONTRACTOR, AS,L
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itate Liccns(!: - 117 ('SApprovedWILLL4M D. GcNEtlICH
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PLUMBING INSPECTOR
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OFFICE
GAS SERVICE NOTICE COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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-----------_.---..__ ..._..........._....._., 1`J,---
To
You are hereby authorized,toc�o n�ecttt t G ,service for
Owner or Tenant -----
At ... - - - ----- -- --- ----- ------- ------
New
---New Service ..../
No. of Meters .. f--------- ---- Reconnect
Move Service .................
No. of Add. Meters .... ------- Move Meter
PLUMBING INSPECTOR
110 7/61-500
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