2182 R06f NO.
NO. t a±R T r
APPLICATI�OW FOR GAS PERMIT
j FEB 2 5 !96 '�OF CUPERTINO
WDate CIT 'E' riA Y / Permit No.�.l��
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
and/or appliances in accordance with the provisions he Plumbing Code of the City
of Cupertino, and all other laws applicable theret %44�1' oZ 'm--
Use
a
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Use of Premises
v
Owner
Mlli ✓0 L'M,014 I,- e//!/l Address ex&10S 41-
By / &AD y Address_
CONTRACTOR, AGENT
Phone Approved77
PLUMBING INSPECTOR
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7DOFFICE
f GAS SERVICE NOTICE rom-
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERT[NO
- ..._.._... - ------- — .r....c1....... Inc. .
To
You are hereby author to c nett tl st�ce for n
Owneror nt ...... ............... ...... .. .. ................... ....
New Service .... ..
No. of Meters ..-.-._�. Reconnect
Move Service _._--
No, of Add. Meters ............ . M ve M er ....... ...
..... ........ -... ._...-.
PLUMBING INSPEC P.
I10 7/61-500
TEMPORARi G'XS SERVICE
DATE: ------ -----c-.r... >�-= Fee: 3
OWNER:
1
LOT: -------- n • n
-19
REASON: ....... ..----.tA'x2 �1'�_-
The undersigned agrees to be responsible fdrlthe gas''service�al�Ehe'above locution,
until the building is ready for occupancy, and is released by the Building Department,
City of Cupertino.
Phone ---
------ ------.-... —G- -Z.. -------- , ._-----
--- --�� �e0 ...
717 1/63-500
INSPECTOR TENANT OR OWNER