1249 LOT NO.
N � 6
APP N FOR GAS PERMIT
,AN 23 19Gi Ci OF CUPERTINO
Daten�wTI p-II��, �194/L Permit No.�
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
(n and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
v
Use of Premises/ �'�" �!
in Owner.�'� ,�.c(�,/�a/�cv'��"`o% Address
By L (� _:— -Addressl4 � w 6e,
CONTRACTOR, AGP.NT
Phonee)/V7-3 y'J'7TApproved
PLUMBING INSPBGT (�
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GAS SERVICE NOTIC. OFFICE
COPY
BUILDING INSPECTOR'S ()FFICr.
CITY 11 1111TINV
I le ................. ........ ....
........... ... ... ... 196-1.
To
You are hereby author' ed to connect the GAS,4rvi.cc for.1
Owner or Tenant
At---
New Service ...
......... ........
No. of Meters ----/............... Reconnect ..............................
Move Service ------------------------
No. of Add. Meters -------------- Move Meter ..........................
PLUMBING INSPECTOR
110 1/60-500