1108 LOT NO.
No. s'rneeTg� - • -•
TI'S �APP�LI 'A
-ION FOR GAS PERMIT
C OF CUPERTINO
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Date � 195_ Permit No.---p Of
CITY OF CUPERTINO Fee s /-
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
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OwnerAwza,� Addr
By.-IflP A i rnf o� � Add,
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Phone Appro
PLUMBING INSPBC
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GAS SERVICE 140 CE °oP;E
BUILDING INSPE.CTOk S IOFFICE
CITY OF 'CUPATIN
...............�..--/��?3..... . ....... 196/.
To
You are hereby autho ' t connect the�: rcice Cor
0
Owner or Tenant -_ .. .- .._--............ .... . . .....-.._-- .-.
At-
New Service ....-~........ .
No. of Meters ------ ------- Reconnect .................. --------
Move Service -----------.---------.-
No, of Add. Meters ...___..... Move Meter .........................
-
........... .--.....---------
PLUMBING INSPECTOR
110 1/60500