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APPLICATION FOR GAS PERMIT
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O J �G— Permit No. �S
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° Ap, ec��ttt'bnppSiherehy,��nn,yydqjqt�}qGity of Cupertino for a permit to install gas pipes
o a and/ tt�►a pliS�ms astli§teA[r 1lthh`1t�CNerse side hereof, and agrees to install said pipes
I and/or appliances in accordance with the provisions of the Plumbing Code of the City
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a w of Cupertino, and o ler laws . Aicable thereto
WUse of Premise
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o a Ow — Address
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o tate License �� 2 ��S Approved \
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IT � /�
TEMPORARY GAS SERVICE
DATE: ...... ..... ..... 3
..................... Fee: ,3--
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,/APR 9 196
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CITY QETCUPERM�Ir'
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RFASON: .. ..........
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The undersigned agrees to be responsible f r the gas service at the above location,
until the building is ready for occupancy, and is released by the Building Department,
City Cut)r1l Phone
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177 1 1/63-500 N PE OR� TENANT OR OWNER