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PPLIANCRM14
U� CUPERTINO
Date •� ., ..... Permit No._11�-q3�__
CITY OF CUPERTINO Pre' s
G
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
appliances in accordance with the provisions of the Plumbing.r'.ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
a y,' OanerCvl�ti�n.C4-�.c, Address
' 2"a ✓
By—
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P}io ,
r I - _ ` i i (PLUMBING INSPECTOR /
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s
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GAS SERVICE NO I 'E�Pce
BUILDING INSPECTOR'S- FFICE
••��""" CITY Or. CUPERTIN . -
. . = 19
�_�
........
To
You are hereby authorized to connect the GAS service for
bv'i�l i1 9�K/ pCYE%!J'�
.Owner or Tenant .-._....... ............------....-- ..........._......! A.. r...............
At ' /127J — .
c.Z...._......................P...1.�.•................................................
New Service ..... �.:......
No. of Meters ....,................. Reconnect
' ;. .. Move. Service ................ r....,
No. of Add. Meters "..: Alove Meter .................
...... ....:.........:.....
PLUMBING INSPECTOR
110 6/59500 -