1556LOT NO.
NO. STREET
® ,'FOR GAS PERMIT
F CUPERTINO
Aq Y 41962
Date I 96—Y Permit No. p
CITY OF CUPERTINO
p Fee $
Application is hereby made to the City of Cupertino fora permit to install gas pipes
I� 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 of the Plumbing Code of the City
of Cupertino, and all other ws applicable the 0.
. N
aUse of Premises
in Owner 't•! -Cl _ Address 0/1 Co 9i SMOL
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ZA�E AMARAL. PLUMBING. IIt Address
` 33919o�ilE§n6toa.,1Lff.RNr _
Phone'SANTA CLA6,fCALIFORNIq Approved `
PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE
BUILDING INSPECTOR'S OFFICE COPY
CITY OF CUPERTINO
..................... ............ --- ................ .. 196..x'
TO
You are hereby authoriz to connect the GAS service for
Owner or Tenant .... ...... .. n.
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At.............. ------- 1�e
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New Service ......
..... ............
No. of Meters ---------I
--------------- Reconnect ..............................
Move Service ........................
No. of Add. Meters ...... Pove. Meler, --- -- . ..................
.......... ...... 4 .... ....
PLUMBING INS CTOR
110 1160-500
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RECORD F INSPECTION
Partial Rough��`�Cy
Rough Complete
Final