2068A
NO. BT
C C� T FOR': GAS
NOV 6 196i F CUPERTINO
Date Oct, 31, 1%2—
CITY OF CUPERTINO
LOT NO.
PERMIT
No.
Fee $
3`
Permit
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/or gas appliances as-li'sted'on'the reverse side hereof, and,agrees to install s'ai&pipes'
and/or- appliances-in-accordance..wit6 the provisions *of the'Plumbing'Code 6f'the City
of Cupertino, and all othei.+laws applicable thereto.
Use of Premises—Residence
owne Deep Cliffe D qn-
L HICKEY S.ON.4 IN
Byl go
Ta
Ph�4R�NYVR4E. Lw 3oRNIA
Address r{ktle�
Address
Approve
PLUMBING INSPB TO
A
m
0
M
-1
To:
You are hereby
Owher or Tenant __
OFFICE
COPY
GAS SERVICO, NOTICE
BUILDING INS0'S OFFICE
CITY OF CiJP&TINO
....................... ..................................... 196_ -----
to co�pect t S s rvice for I Y,
2 _ .. .. ... 4�a�4
�0. Ams szc
New Service ....G -------------
No. of Meters ---- / ............. Reconnect ............. ....... .......
Move Service ........................
.,No. of Add. Meters .............. :,Move Meter...'-,-, ....................
. .. .. .................................
PLUMBING INSPECTOR
110 7/61-500