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LOT NO
NO. STREET �// i I^•?•
APPLICATION F R '�4PPLIANCE PERMIT
C OF CUPERTINO
Date 19G.:�' Permit No. •'
Fee Z 1
Application is hereby made to the City of Cupertino for a permit to install '
Q gas appliances ks I�ted�bn,'the reverse side hereof• and agrees to install said
appliance;inla�ordance-wi Aelproxisiens of the Plumbing rode of the City
of Cuperti io ndAa14 tier law9s applicable thereto.
. Use of Premises t f �,•'
.l Owner ^ uiAddress
Address vl
CONTRACTOR AGeNT
Phone�f" (-S S7� Approve t1 ^i c����///✓
' • � i PLUMBING INSPECTOR
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`ON'
<,GA$?SEaVIE`+�NOTICE �
1�ISlyTOS"OtPICL%?>
o
:, .•:• : ,CITY INQ'
... ... I�p
To
YouarAereby�4Eh rized to connect the GAS service for
Owner or Tenant .. .�� �. .t%7,_/��Gl��,t�C/,: SGC/,--
-- /
At %d3eel - - -
New Service .... .............. t
No. of Meters
Reconnect-
.. . P `•t s �c�vN�
�' '.,Move'jSer`vice -
No. of Add. Metas'.`......- Move Meter ........._...:......:....
- x .-..... . - ..
PLUMBING INSPECTOR
Sr.l lo,6/59.500