106 V0, LOT NO.(Z ,.
NO. STREET IQ n•
JarL N FOR S PERMIT
D I OF CUPERTINO
�
m 2 960
Date ""`�� ° 95 Permit No. '�U
CITY OF CUPERTINO Fee $ i
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.
�a
W� d, Use of Premises iAZ-Q_e�
2 Owner Address
By -DIVISION Address
„�„i`"� Phone 5pavwls herr d.R'Sana b Clara, Ca APProv U ..L'ftli'I/t��
/ PLUMBING INSPECTOR V
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GAS SERV N Oqc COPY
BUILDING INSPECTOR'S
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CITY,OF(AJPERlIN0
• ------ --- ------------ -/ ....... ......... .... 19.
To
You are hereby authori d to connect the GAS service for
Owner or Ten— --------------
...........
At
New Service ............. .........
No. of Meters .... ....... ....... Reconnect ----- ............:............
Move Service.:.......................
No, of Add. Meters -------------- Move Meter ...........................
I
..................
PLUMBING INSPECTOR -
110 6/59-5()