1765IGSA \AC-bU_\�I bY���f� LOT NO. /O _
NO. STaeB -Z CCCC77
F��AP OISA ION FOR GAS PERMIT
oUN 8 .196X. F CUPERTINO
Dateyys"�5_ Permit No.�_
�JJ'tj� "�1 Fee $_`2 �=o
Application is hereby made to the City of Cupertino for a permit to install gas pipes
. 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.
u
Use of Premises— �
.L 737 9 zua✓
Owneyr'���/eii4�+c', Address
BY 7n `�"l %. �Ll Q. Address' �a Bell
- .CONTRA TOR, AGENT ' 1
PhAPProved
INSPECT
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GAS SE_RVICE',NOTICE
BUILDING INSPECTOR'S OFFICE'
8 CITY -OF CUP•ERTINO
----------- ---- ...........
To
You are hereb authoriz t Ifncecf e GAS servlc f r, ..
Owner or Tenant ...... ...
At---------_-------
No.
-- ----_------ No. of -Meters ....._------`.....:...
� No: of Add. Meters :............. .
Ito 7/61-.5oo
OFFICE
COPY
t9Cy
New Service .......
Reconnect
...........----
r
Move Service
M e Meter _ "W+
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PLUMBING �INSP R .