1106 1 (o Irl C CL21 l l LOT NO. /L
® A�PPLIfLATION FOR GAS PERMIT
FISEP :30196
OF CUPERTINO
IDat n' 195_ Permit No. 1166
lid �IY� 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 of the Plumbing Code of the City
of Cupertino, and all other laws ap licable thereto.
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Use of Premises
65 Owner Address
B�oe Amaral P! Imhir Address _
CONTRACTOR, P.1;1 �
Z_" hone Approved
PLUMBING INSPECTOR
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GAS SERVICE 'NTI E' OFFICE
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BUILDING INSPECTOR'S ;OFFICE
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CITY OF CUPIiRTINO
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...._........_,..?... ---._�_... 196.. .
To
You are hereby wthorized to connect the GA service for
Owner or Tenant ...(,...G.- 4 ._.. ..1 '.r�.�� ���i.�-^.v-C./ --.-..-..-
-----------------
New Service ------ ..........
No. of Meters ------ ...... Reconnect
Move Service .......-----------------
No. of Add. Meters .............. Move Meter ....................-.....
................-- -----
LUMBING INSPECTOR
110 1/60-500