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2188J� LOT NO NO, rSTBBB N < � �APPLI - TIOM�N5 FOR GAS PERMIT z — i UPLRTINO <-.v fo �FEa.2a�as�, CITY OC �C�f,:,, ° a Date /�o/Z'- ../ r,'.:. 6�i3 %,'Permit NoiC_ dLL Y CITYIAz I,� — - Fee•$ ; 0. lApplication is hefeb} maoe'to the Cityrot' ' ertmo fora permit.to install gas pipes Ip and/or gas appliances as.fisted-on-the.reverseesiderhereof; and agrees touinstall'said pipes >.� , and/or appliances in-a theaProyision; oF`the Plumbing Codeloflthe City z m of Cupertino, and—all-ot e�laws,apphfable.flrereto. a n. Use of Premises...., ' ..J^• M;' ._r - - 00 / " a , Owner AddressUlG L z-i�(\ z ByA'ddressp � 0AGENT' •3 � . - w Phon i ,.• ,w • . 1w z � State License ` Approved 777 P t V s6r� Jo', .J You are hereby Owner or Tenant .... 1. At............ ` oPP GAS SERVICE NOTICE COPY BUILDING .INSPECrOR;S' OFFICE CITY OF. CUPER :.... _ �. xuthzed to connect the G� service .foY1 r /1 lop No. of Meters .................... No. of Add. Meters .............. 1" New Service'y....._k��..... Reconnect .............................. Move Service ........................ �MOe Meter ........................ 11, of lel 1' ...... ` .a... PL .r--. ..UM[ 110 6/63-5011