1263i Ck c(10 I C tZ R I t LOT NO.
STR
SIDI
APPL CSON FOR GAS PERMIT
TJAN 23 1901 OF CUPERTINO
DaCI_�_T O �}kb 11.___ 19e1 Permit No. i Z 63
m `i�" �I�����U Fee$ ISD
1�I Application is hereby made to the City of Cupertino for a permit to install gas pipes
J 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.
v ,
u /
aUse of Premises
l Owner l�vx-L,--a-� _ Address
/ By Address
lC CONTRACTOR, AGENT
PhoneVIY7— 7q'77 Approved
PLUMBING INSPECT OR
SERVICE 140�ICE COPY
.GAS SER OFFICE
BUILDING INSPECT tR'�S VHCE
CITY 01' CUPE TINd)
....... ... i ............. . ..................................... 196.1
To
You are hereby autlaorlz to connect the GAS service for
Owner or Tenant ........... . ... ....
At .....
New Service ...
. ....................
No. of Meters ...../--------------- Reconnect ..............................
Move Service ........................
No. of Add. Meters -------------- Move Meter ..........................
110 1/60-500 � BING INSPECTOR