2185 LOT NO.
STREET, -
APPLICATION FOR GAS PERMIT
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'CITY OF CUPERTINO C
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a Date
Ox - , y
3 1962
T Permit Nor
Application is hereby'made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
> and/or appliances ifs=atcordante with the provisions of the Plumbing Code of the City
a W, of Cupertino,-hnrj,,gll.oth laws applicable•themutc;.
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Use of Premises,
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3
Owner-64& 5-� Address
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z zByl/�l Address
CONTRACTOR, AGENT
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— m Phone
< a State License Approved gs�3 Approved
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PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE
COPY
Cp Z BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTrN ,
.....................L�.. ...-_...�................., I9
To
` You are hereby authoriz d .to connect the GAS f\er>ice oO I .
Owner or Tenant ............... �"' ' 1, .....................
At ...............1..1.Z�..Z....................... �...........a ........ ..............
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New Service ..... ,
No. of Meters ........I............. Reconnect ..............................
Move �ervice ........ ...............
No. of Add. Meters .............. Move Meter ..........................
........... ............ ............ :�..................C..
i� PLUMBING INSPECTOR
110 6/63-500 - • -