2280 LOT NO.
NO. STREET
APPLICATION FOR GAS PERMIT
z CITY OF CUPERTINO
2
Y O
3 ¢ Date_ 1963 Per
No��✓ d
U Fee S / o
' 0 Application is hereby made to the City of Cupertino for a permit to instill gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i and/or appliances in accordance with the provisions of the Plumbing Code of the City
w of Cupertino, and all other laws applicable thereto.
w
Use of Premises AL,
00
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o a OwtSc (? . Address ( ;,_=/�.��
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3 _ O D ACTOR, AGI3}
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z
i o State License-J6- Iq Y3AlI Approved
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OFFICE
COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO /
To
You are hereby authod to connect the G service for
Owner e ....
or Tnant .. -�.
J
At . fv.-{�
/ New Service .._L'..._....._.
No. of Meters ---.....----.......... Reconnect -.
Move Service
No. of Add. Meters ......... Move Meter...._.......__.........
PLUMBING INSPECTOR
I o 7/61-500