772b
LOT NO. l
NO. STREET
AP LM1962 c
Date ,9 A(� _..-
�NN Ap�l1c'dNonTSR�ereiSy�'�iilaWTIMEity
1 p gas appliances as listed on the reverse side h
ln� app:iances in.accordance with the provision
of Cupertino,' and all other laws apo [cable
Use of Premises
ROT�I,§HEET: ETAL, I
<hvne 3
CONTRACTOR, AGENT
APPLIANCE PERMIT
UPERTINO
Permit No.
0 0
Fee t�n
of Cupertino for a'permit to install
ereof, and agrees to install said
s of the Plumbing l:odeof. the City'
thereto.
aL t✓
Approve
.,i i �• PLUMBING iNSPECTOR
C)
to
i - OFFICE
"' COPY
',bAS SERVICE TICE
BUILDING. INSPECTOR OFFICE -
--
f - CITY �. OF CUPERTINO
Lts
.
� . ?....."", 196.
To
You are here y authorize to connect the GAS '
•.: Owner or Tenant _.."""".
..---.._-- - ---- - ---;
k :Ai-�
- • . _ .a. 1 .�; - New Service-
, ,
No. of Meters ........ M.•.:t;f `"" Remnnect .=r":"t x `---.-
..,..-.t�,. -- --._
Move Service _, -
e
No. of Add. Meters --- :.:...... '3� .s a, ve eter..
5--------- =----------- - ---
r,fw 'PLUMBING INSPEC O
-110 7/61-500