1580 O. STREET
g �4 ION FOR,GAS PERMIT
Datep�q ry Q r� OF CUPERTINO
__ 195_ Permit No. `
n1'F q/�� PERT Fee $ `�
C��plicatio�is t by mad tot a City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions f the Plumbi Q Code of the City
of Cupertino, and all other laws applicable thereto' I1I/
c
Use of emises
iOwner Address
BY Address
CONTRACTO , AGENT
Phone — I Approve t
1 PLUMBING INSPE O
K w O ts7 a 'O
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8 3
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A J
GAS SERVICE' E OFFICE
COPY
BUILDING -ICE
r
1�4sp OTI�
OE �C ,611 or
. cup .
CITY R NO
..............
To
You are hereby authtrized to connect the GAS service for
Owner or Tenant ......... . .. -g.------... ---- --- l.J z---.CA ........
At -------- ......... ....
New Service –-—–------------
------------
No. of Meters ........I.............. Reconnect ------------------------------
Move Service ------------------------
No. of Add. Meters .............. ove Meter ..........................
.......... --- -- ..
.... ...
-----
PLUMBING I E OR
iNG .....
110 1/60-500