1621 NO. STREET
JAULICATION FOR GAS PERMIT
[P ja �F CUPERTINO.
1962 �: a
Date 1S_ Permit No.
pd
C 11TTFee $ '2
A�LIv~a`'�ono`here ity ofCupertino for a permit to install gas pipes
and/or gas appliances as liste on t e'rtverse side hereof, and agrees to installfsaid pipes
and/or appliances in accordance with the'piovisions.of the Plumbing Code of the City,
•`t of Cupertino, and all other laws applicable.there'tvo �4
J n 4
Use of Premises APARTMENT, ,
Owner la RAFA4CSW SME Address
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i St- •�'at 2OO�C(14(t
P118f105 CTORVAG.
f 9a Approved
IIOf�E�...�. � U
PLMEING INSPP.CTO , (�
t; ,n^P
.Pho_np 777.5g90 °�._- .--• .� 1 1
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OFFICE' --
COPY
-` iAS SERVICE � TaCE
BUILDING INSPECTORT OFFICE -
CITY OF CUPER NO
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............------._.....:_.._....., 196.2
To
are her
authoriz toconnect the GA se vice for
Y F L
At _.�. -
- . ;,•.:5�'• ' New, Service . ' ---
No. of Meters :_`---...... --- - ,.:.Reconnect ,
.............----�-----`.
.'Move Service-.. .........
M;
p r No of:Add Meters
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LUMBING INSP� T R "�
.'i 110 7/61-500 .