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LOT NO.
APPLICAT FOR GAS PERMIT
JAN 23 19 cuPExTINo
Date /—/� Permit No.
GUY Ur UU.
✓� 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 applicable thereto.
Use of Prem,ises
�n Owner C��"``'–�"•�G�-- "`�"� Address
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gyl/frl_ /uc�/���• Address/y4 r�r .
CONTRACTOR, AGP.NT /' 1
Phone C//If7^3c.�-77 ApprovedS
PLUMBING INSPEC 0.
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GAS SERVICE- NOTI E OFFICE
COPY
BUILDING INSPECTOR'S 0 -'ICE
CITY OF CUPERTINO
................ ..... .............. 196./_
TO You are hereby authorized to connect the GAS ervi.cc for
Owner or Tenant ... -- -------------- .........
G./e2 C ,. ......... .... .........
..................
At..,/.
New Service
..........................
No. of Meters ---/................ Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. Move Meter ..........................
e�.PLUMBING INSPECTOR
110 1/60-500