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APPLICATION FOR APPLIANCE PERMIT
JJAN 17 1'63CIT]_OF CUPERTINO 8 if s -isr.��pi2
Date �,?i �, 196.:x.. Permit No.
Fee $ b
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of
Owne C ' % G -axr ve2 t
r. By c`4
+pi CONTRACT , AcaNr
Phone AM 0 1
5
GAS, SERVI E NOTICE
BUILDING INSP OR'S OFFICE,
CITY OF ERTINO
..........................
To
You are herebyauth i d to
Owner or Te X'40e
At
No. of Meters .. ................ Reconnect
.............. ..
Move Service ........................
No. of Add. Meters ----------- Move Meter --------------------------
A
.........
'PLUMBING INSPECTOR
110 7/61-500
OFFICE
Copy
---- 1 196%,1).-
servi
'c
........... .. e ---------------------------------
New Service ---«..............