1250 � -
*LOT NO. �l'
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E 1
Q p� Ap(t I TION FOR GAS PERMIT
'JAIr 2� �t�"' OF CUPERTINO
Dae _ - o.
� 19T�1. Permit N
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Fee $ Z' :5'0
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.
8 Use of Premises /'Z
ti Owner�" d , �� � '�' Address
I i, Address/yl/� '-'�� ✓✓c+v� /,�/�+
J�J CONTRACTOR, AGP.NT
JY-5 Phone ON i- 35f77 _ ApproveAU
U 181NG INSPECTOR
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GAS SERVICE NOTICE
i,COPY
®Purr.BUILDING INSPECTOR'S e4
CITY OF CUPERTINO
.......................... . ............... -------- 116J..
To
You are hereby authori d to connect the GAS service for
Owner or Tenant ..... ... . .... .. ----
4-zz�t-��---------------------------------- .............
At.. 2
New Service
---------...............
No. of Meters ... ---------------- Reconnect ...... .......................
Move Service ------------------------
No. of Add. Meters -------------- Move Meter ..........................
- ------- --------------------------------- ----------------
LIJMBING INSPECTOR
110 1/60-500