2177 p'ZIDt 1 I IAT No. y3
STR ETc( '�
APP L'ICAT�ON FOR. 'GAS PERMIT
i i 11OF CUkRTINO
FEB 1 g �Q6 Ti
3O
Y LL �
3 w LL J . .-. 1 . `N(196Permitll— •toe.u
.
= o
� Application is hereby made to the City of Cupertino for n permit to-install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
,ZN and/or appliances in accordance with-the provisions•of the Plumbing Code of the City
a W of Cupe'r'tino, and all other laws applicable thereto.• - -
j a ,Use of Premises - -
oo. ,� •
..> m ,�l
Adress
`Q OwnerlS o �1L ( co i lz
(( .:h•y ry'
� z B .•^'/ } 1� ' ;Address - 7_lYJ '.�'.�' .., .. Y�, ,r
J o y� 'CO 'OR,AGENT
< a 'State License I Approved b
_u
_......•--•'*"'�r��«,< _ ,.icy ,. PLUMBING INSPEC7 R+..
y & z R \ C) CAC)
\
! @/
! ! � } (
� kw �
ƒ m
« E
§ \ \ƒ
�
� . (a
OFFICE
• COPY
GAS SERVICE-NOTICE
't BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
19
To
You are hereby auth Ulo necttOwner or Tenant ._..--.-- ......-'--............. .._..............-. .-----...
At ............. ..1.1 J............: �xl.V........ ---
New Service ------°%......
No. of Meters ........1............. Reconnect ..............................
r
Moe Service ........................
. � No:of'Add. Meters ...::.::.....� .' '.�, , ''1M a Meter ..........................
' � t
PLUMBING, SP CTO
- - .. I ILZ61-500