139 LOT NO.
NO. STREBT
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date t 196--- Permit No. _
,�g60 Fee s o
ApQIc ns� �rc%y made to the fS�I, of Cupertino for a permit to install
gas appliis 5isted on the re r���IktMereof, and agrees to install said
appliances in accordance.wiei ovisions of the Plumbing bode of the City
of Cupertino,^ Ther aws applicable thereto.
Use of Premise P S
J� Own �J .H` v Address 01)
gy�� I-10s, /,e Address
NTRACTOrR AGENT 1 - I/
Phone i - J �¢ Approved
t I y i I I PLUMBING INSPECTOR
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GAS SERVICEl N" TACE ry OFFICE
BUILDING INSPECTOR. QYFIC I E
CITY,OF CUPERT 1
.................. ..........................
To T
You are hereby authorized to connect the— AS service for
.... .. . ...
Owner or Tenant
............... ..... .... . . .... .
. .. ....
At
New Service'. v......_.......
No. of Meters ------- ..............
Reconnect ...............................
Move Service .......................
No. of Add. Meters ......... ....
Move Meter ....:.....................
...........
........................................
PLUMBING INSPECTOR
110 6/59.500