1109 f q Lqa , ` C fz R I V LOT NO.
NO. STRa P.T
' ` ?*0 j TIG FOR GAS PERMIT
E I ;OF CUPERTINO
Z3 960 �, O
Date 193_ Permit No. /� 9
CITY OF CUPERTINO Fees Z410,
Application is hereby made to the City of Cupertino fora 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
a� of Cupertino, and all other laws applicable thereto.
UUse of Premises
r7 Owner Address_
B40BAmmrnl���� Address
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�� CONE Phone Approv
I PLUMBING INSPB ,QR
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I� GAS SERVIC ; NOTICE„ orrice
/ COPY
BUILDING INSPE OR'S OPCICE
C[TY OF C PERTIN
�.. s. _..... _ . .. ... .
To /
You are hereby autho ized t Connn�nect�ct the CAS service for
Owner or Tenant -.�:.':...1 ....---.
At..... --------- - 7 - ...
New Service ....--....e v
----------------
No. of Meters ._..�............... Reconnect ------------------------------
Move Service __........_----------
No. of Add. Meters .............. Move Meter -----------------_-------
------...-----.----
PLUMBING INSPECTOR
110 1/60-500