711" F ® I 110& i -LG n.0 LOT NO.
NO. STREET
zFOR APPLIANCE PERMIT .
OF CUPERTINO
VtefFEDtYoa , 196..... Permit No.
CITY. OF CUPERTINO Fee a 1
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 rode of the City
of Cupertino, and all other laws applicable thereto. j
Use of Premises L -/L � - - - j
u
Owner ,/� _ Address
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By HEATING &cDHNIOM�IAtG00.- Address_
M6MNYOAKS AVE., CAMPOEI CALIF ` Approv
PiUMEING INS TOR
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GA RVICE ;NOTICE °orYE
y BUILD G,, INSPECTOR'S? OF ICE
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C TY`•`OP CUPERTIN Q'>..
{yr
19C
To
You are hereby aut zed to connect the GAS service
Owner or Tenant .:... ...... ...lY.-fent
At ...,/..13111 1 ... � .: ..........
New. Service --- .:�..............
No. of Meters }! More Set ................................
............ `
eryue .
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No. of Add. Meters Move Meter*:R
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ti PLUMBINGINSPECTOR
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