2277 :�t7E7(7 A �,(i��/Y'fs..• //1 LOT NO. y
NO. STREET
APPLICATION FOR GAS PERMIT
z CITY OF CUPERTINO
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3 U Date _ 3 ,. 196, Permit No. -V 77
_ . . . Per
o 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
iN and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, :in(] all other laws applicable thereto.
Use of P//rre/ee/�mises00
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,"z Owne �J- Addressl
o By Address
3 F 6NTRnOR, AGENT
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i o tate Liccnsedi'6 �.5— .- - . Approve + �'
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PLUMBING INSPECTOR
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OFFICE
y�y GAS SERVICE NOTICE core
BUILDING INSPECTOR'S OFFICE
CITY OF CUPe12TIN0
- ----- -- -- - -- ----------.. .......
To
You are hereby authorized con ect the G S s ice to
Owner or Tenant ............ . . -._. -.
At ... G�...l .�Q..l.�—.....�C......
New Service __ ......._.......
No. of Meters / ---------- ---- Reconnect
Move Service
No. of Add. Meters -------- ----- Move Meter ..._......__.....__.-
PL MBING INSPECTOR
110 �/Gi-soo