1094 / / GGO ' _'�•i�- LOT NO,
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❑AV/t G'YsC �•t 1
A gP C rtION FOR GAS PERMIT
AUG 2,1 �70� I•rF OF CUPERTINO
Dam % .a19�— Permit No. / 0/7
Fee $_
1" 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 applicable thereto.
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Use of Premises
in OwneAddress_
By Address
CONTRACTOR, AGENT
Phone !�x -� _ Apprn
$' PLUMBING 1 E
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GAS SERVICE' 'NOTICE tt/ °OPY
.w BUILDING INSPECTO,iiS OFFiCi f -.
CITY OF CUPEkT N
..... ........_.�� �_............................ 196_Q.
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You are hereby authorized to connect the AS ervice for
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Owner or Tenant ------ ya4 --
At
/..p��a...--- ��...1 - - - —- .._.... - -. .... ....... ..New Service ..........................
No. of Meters ....../............... Reconnect .......... ................
Move Service ........................
No. of Add. Meters -------------- Move Meter ------._. ..............
PL ING INSPECTOR
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