1609 L b 2 [ (�. �c��� ek 9,�eQ o �c� ;� �
� cio. srneer ' ��
�P„EI �I FOR GAS PERMIT
pc� QF CUPERTINO
c F: ..
Date ' QP • �9v� , t�'1� Permit No.��S�C�
�, o
App�I�� n� �� Fee $_r�.
c'efion is'hereb��PE��hI'Cify of Cupertino for a permit to install gas pipes
. and/or gas appliances az listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in atcordance with the provisions of the Plumbing Code of the City
� �� of Cupertino, and all othet laws applicable thereto.
° APARTMENT
� �
. � Use of Premises ��'NU�C � O �
v . •7 a �,.-a�;-P
� PHILIP RAFALOW, INC.
�n Owner �} • Address �
� ��1�4M`�� �
� By-2gp sF{S{��{�_� Address
, Camphe(t°� I�°(�i o nla� �GP.NT /
Phone�peflC�.�566�—_ � Approv
� , PLUM0ING INSPE
� I�1 z � ,9 � �I o` Fnl� yl � n � � lA Cl 4� � w
c,�'b 9 �. '� , � i �i . o -� <. �, a o � �n n �. ro �I 7y'� -
n.l ❑ � �' � m rt F a. 'i7 � � N w n' G Oo � °��'I�n T
I ' O
> m ..' O � m � °c� I n C �� 0. -e� � w 'S ^ �� `o
�. `e ry � w �p , � `p
v n � v�i 9 " " y u � � � � w .
� � G� 'O � n
v
a __ y ' o
� � —_--_—_
,� ro � ------------- �
� � --__—
o �' _ z ------------- H
y : /� --
R 4� v ' �
� 9 :• R
N N
R .
' T —I —
� � I Q �
_ --__w
� ; — y ; ----------------- ��
ro i v �: ' 'f°o -.
y
O : A ', � � I
A ', � . ---- _ __—_---
�: ` ' I I I ------�R� I
I /' ' � GAS SERVI'CE�NOTICE � ,:;/ oFrics , �
`1 (� .e%; COPY .
Z \ BUILDING INSPECTOR'S' O�PICI:
0�' 4 ,CITY OF CUPERTIN
; :....... :-.��.�.!.. ....7..._....._.........--...._..., t���
To '
You are hereby adfhori d to conn�t,the G S`er�icc for •
� • ,
c. ��
Owner or Tenant .,_: ................._--. .
_._._. ... ,..-- ......-c:-.. .. .. �
_-- -..'...._...--�-
lo2� b - 1 � -y � � � �
ar................. .................... ...... - -.... .. --. c
_.............�.. -
II � � New Service ...:...�.....
No. of MMers .---..�_.-_ Reconnect :....--_-..._---------------
� . .. Mo e Service ....--=................
� No. of Add. Meters ....._....._. r\. � Meter .:.._......:...:...._--.
/�
p�'�v , -
_ ................................................ . .. ....� ..
� PLUMBING INSPECTO
110 1/60-500 ,
�