143 LOT NO. f
NO. 4 STREET
r APPLI /ATFOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date '_" 196... Permit No.
Fee S.
Application is hereby made to the City of Cupertino for a permit;to install
;
Q gas appliance's as listed on the reverse side hereof, and agrees to,install said ,
appliances in 6P s d ith the provisions of the Plumbing lode of the City
of P m jart"d�a11 laws applicable thereto.
Piii
nses
O'n�r _ �A�ddress O
t-0-V!
. Address2�
CO ACTORi AGEN
PhoneApprove uf11✓� !z!iJ`+ec
PLUMBING INSPECTOR
rk 14n �d'S. {.,�t �S T1. , �� '{,}., 2•j>.} C?ti..
c GAS SERVICE 4 � Co r6F�
LR I '-ti 1 �wR y�4 BUILDING INSPECTOR Y �I _- ,-
a a rr y CITY
OF CUPERT \T tyr
t
'^TU tta n . � ,' ` ♦ ��,'4 '
You are hereby authorized to connect the S se,ice for
•. Owner or Tenant .........
�......; -........... _............................. ..... ........
l. . .. . .' :_• , y New Service -
No. of Meters:: `
... - 'Reconnect....
�rf4, Y $ .t 5 r i # ' ,+Move
'•5- Jr'No"-of Add eters' .. "F _ Mole Meter .c '
. t
..
PLUMBING INSPECTOR -
nn 9/59-5on
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