145 LOT VO. 2
: !:•NU. STREET �GF ' `mow/ U rC�O17J
® I FOR APPLIANCE PERMIT
ITY OF CUPERTINO
I(API 8 0 ' .,
Date � / t9G.� Permit No.�—`7"''
t� CITY OF CUPERTINO Fee s-- / "—=
•-O Application is.hereby made to the City of Cupertino for a permit to install
Q gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing r':ode of the City
of Cupertino, and allotherlaws applicable thereto.
Use of Premises
J� Owne /_t.✓Address - O
gyfCLA��CLfr�oS hreT�ji7.� Addre
t CONTRACTOR, AGENT
Phone )2- f"q Approved
PLVYEING INSPECTOR
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GAS SEKVIC'tOTICE OFFICE
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BUILDINGUNSPECTO 'S OFFICE CO.ly
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C[TY OP:GUPE INO�
7. 3..... ................. 19(d
To �.
You are hereby authorized to connect the GAS service for
Owner or Tenant .... U .. '�r.�.. ........ ..........:........
At _ ..... �-e. - ... _..... ......
New Service .....v
No. of Meters ... ............... Reconnect ..............................
Move Service .........................
No. of Add. Meters .............. Move Meter
PLUMBING. INSPECTOR
110 6/59-50n