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P
ArPPEIGATION FOR GAS PERMIT
I
UVITY OP CUP17RTINO
AUG 13 1963
Date 196_ Permit No.
CITY OF CUpERT; �I ' Pee $ °=
A pplicatioA 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 of the Plumbing Code of the City
of Cupertino, and allitller laws applicable thereto.
Use of Premises
Owner
By
CONTRACTOR, AG
State License
-Address
Address -ry tA_ ti
Approved
N1 A PLUMBING INSPECTOR
GAS SERVICE OFFICE
,.G INSPECTOR'S OFFICE COPY
BUILDING
,..
CITY OF CUPERTINO
/
.................. ...... .. I - --- - D� ............ -- ...................
To
You are hereby arized to connect tGAS service for
Owner or Tenant
................. ......
At ......... ..
....---..:.R.._...---_.._....
New Service ......
No. of Meters ..._....L.........-. Reconnect
Move Service --------- ..........
No. of Add. Meters .............. yMove Meter ..........
tPLUMBING ISP4 CTOR
11U 6/63-5oo