2265LOT NO.n
No; i STREET
APPLICATION FOR GAS PERMIT
w i Or CITY OF CUPERTINO
p fr','AY 7 1Q '3 t._
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o J Date.. a 5
0 a .196— Permit No.
1-4
F o Pee $
LL w Application is hereby made to the City of Cupertino for a permit to install gas pipes
0 a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i In and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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`0 a Owner i ' �'t_ ' Address
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J JBy CONTRACTOR, AGENT Address
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w 0 State License/ /G�7 1�7 1 Approved
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. �� PLUMBING INSPECTOR
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/ OFFICE
1 COPY
D GAS SERVICE NOTICE
` BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
------------ ----- -.'. ...... ............. 196.�S
To
You are hereby authorize con ect the
//��-A�G,aervice for
Owner or Tenant --------
----------
--........._.
At
/ New Service .... -..
No. of Meters .--l ................. Reconnect ................_........
Move Service ------
No. of Add. Meters ------ ------- Move Meter .....___...............
............. .. ........
PLUMBING INSPECTOR
110 7/61-500