1045u
180
LOT NO.
'PPLICATIONFt}R APPLIANCE PERMIT
f N QV 2 7 1962 C: SOF CUPERTINO
Date nlfVdd 196
t761K4 1(l11eg...._. Permit No.
1, V ^�
Fee S
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 bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises.
r
Owner &�N a, 4 - _
By DIVISION
HEATING & SHEETOMFFffETWAGENr
E.ftonern+.us AyF CAMPBELL CALIF.
Address_ _
Address
Approved
PLUMBING INSP
a
OFFICE
COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF, CUPERTINO
,To .......
You are hereby authori A to connect the GAS
Owner or Tenant =Ice or
------------
------
New Service--i - — -----------------
No. of Meters .../----------- Reconnect ------
Move Service
No. of Add. Meters -------------- Move Meter
...................
- - - ----- ----LUMBING - INSPECTOR
110 7/61-500