1264 IWI ✓ Y V 1 X J 1 Il LOT NO,
NO. Q BE� r
�V PLfCA ON FOR GAS PERMIT
.�JAN 23 19G1 OF CUPERTINO
Date /_/21 -(11194_' Permit No.
CITY � Fee $ �'Sy
(� 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
lO 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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35 Ownet(� Address
Address/ K _�
CONTRACTOR, AGENT O
Phone 3,f 77 Approved — -
PLUMBING INSPECT
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GAS SERYlrE, ,NOTI E� COPY
OFFICE
BUILDING INSPECTOR'S OFFIC
CITY OF CUPERTINO
.......... ------ .......... 196./.
To
You are hereby authorized co d to connect the GAS service for
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Owner or Tenant ...... .. ...
At -A?,rZ26 i::;�te,-------------------------------------------------
.......... . ... .....
New Service ..........................
No. of Meters .../.......... --- Reconnect -----------------------
Move Service ........................
No. of Add. Meters -------------- Move Meter - - ---- ---- -*-----
------------------
PLUMBING INSPECTOR
110 1/60-500 -