2181 OT NO.
NO.
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APPLICATIO,N FOR GAS PERMIT
J FEB 2 5 11963 CRr,-OF CUPERTINO ,, �
Date g ,I`795�.iz Permit No.___C'^^u"/
CIT r c -1 Fee ,S V d L
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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
f
and/or appliances in accordance with the provisions the Plumb' C��e of the City
�3 of Cupertino, and all other laws applicable thereto �a —
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Use of Premises r
u
In Owner_ Address A'BL LL
By P///r'D y //,L l//Y,.9/ntb Address ,d'GL
CONTRACTOR, AGENT
Phone 7rE— E//l Approved
PLUMBING IN5PE(7cOR
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A A
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OFFICE
GAS., SERVICE NOTICE AoV,
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
To
You are hereby auxtw;z��
vice for
Owner or T ant
..__ ....
O
...........
1 New Service ----- ..✓....—
No. of Meters -._.L. --------. --- Reconnect ......
Move Service .. ._
No. of Add. Meters .......... ... M ve Meter - ---------------------
PLUMBING IN EC OR
110 7/51-500
a
TEMPORARY ' GAS SERVICE
DATE: ---------------- Fee:
-------------------------
OWNER:
AT:
LOT: ...... -------zt-m�.. .... ........... . P,Pv...k
REASON: .......
The undersigned agrees to be responsible for-the
.iblTYT-UPERP-NI(I"
gas senice at the Mve location,
until the building is ready for occupancy, and is released by the Building Department,
City of Cupertino.
PhoneX
------- --------- - -------------------------------- --------------
-
717 1/63-500 INSPECTOR I TENANT OR OWNER