2357 �O1067 I //II/YJ(�CCL6 LOT NO. J /NO. STR9EF
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,OA FOR GAS PERMIT
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�CITYI OF CUPERTINO
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3 ¢ Date 1961 Permit No. _
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Application �hereW- a a the'City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees.to install said pipes
i N and/or appliances in accordance with the provisions of the Plumbing Code of the City
¢ w of Cupertino, and all other laws applicable thereto.
LL Use of Premises00
o a Owner di/I�YA9/l d Peri. V �/�- Address�Ny/.��-r'��
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Z By .(,lA,C�[I /� .C(//77�/I7l! Address
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rc a �36 ,� WILLIAM D. BENI_VICH
� E„ State License Approved
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PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE
COPY
/ BUILDING INSPECTOR'S OFFICE
CITY OF CUPERT r/
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To
You are hereby auth ed conned he S service for
Owner or Tcua ........ (L/..................... .... ................... .. :C;hQ
At .....--- .s.:.......` _. .. :.- -----------------------
New Service ..... ......
No. of Meters ..........�.......... Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. o Meter
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PLUMBING INS Tf
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