838A q, Qte- ` r' LOT NO. / O
NO. STREET
APPIe1CATJ ' FOR APPLIANCE PERMIT
C • ;bF CUPERTINO
8
Date 19G -•P?. Permit No.
CITY G� C�IPERTl�!0 Fee s /.2
Application is hereby made to the City of Cupertino for a permit to install
gas. appliances as listed on the reverse side hereof, and agrees to install"said
t appliances in accordance with the provisions of the Plumbing rode of the City
.:. ofCupertino, and all other laws applicable thereto.
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By .r/_U fieri Addressor u_
CONTRA TOR, AGENT
Phone ;0 te;G; Approved ;
PLUMBING-INSPE
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Owner or Tenant
At --- - --- __1 Ey
- OFFICE
COPY
GAS SERVICE _NOTICE
BUILDING INSPECTOR'S OFFICE -
CITYd'OF -CUPERTINO
tho ed tnnec h'e GEIS service for �— . 1
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.,No. of Meters ----- --- �±'.._r..
- > No.,of. Add. Meters --------
,110
--. .I10 7/61-500
New Service ._----- —
Reconnect
-,Move Service ...... .._....._.......
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ING IN