562 LOT NO.
NO. STREET' - -
eI�PPMA 15cl
FOR GAS PERMIT
CF CUPERTINO /.
Date t .� �tb, Permit No.
YY.. .((��� r(�''II ��TT � Fee$ S�
r Aq�IcStiott'Is heYegy�ll,? tl't 9City of Cupertino for a permit to install gas.pipes.,,
1 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.
Use of Premises
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17 . OwnerLeJA` J aXy rA n CA lA ' Address
By_(AIAVK1t_ o �.k li0 Address c c( A
._ COrNTRACTOR�AGENT
s Phone l7 ��5 O r -Approved
PLUMBING INSPECTOR /xV
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a;- BUILDING,INSPECTOR'S',O DICE_
CPERTINO
ITY,OP'CU
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To
You are hereby authorized to connect the GAS service for
Owner or Tenant �....l�i_!yr��..•-.-(_/ �� ��G�1jO
.............................................
At
New Service ...✓...:-............
_ No. of Meters ...... .......... Reconnect. .i.--...--...............:.
• :, : ;, . .
' Move Service :_.....................
No. of All, Meters .....::...... Move Meter .....................
PLUMBING INSPECTOR+
..
110 6/59-500 - t
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