1999 -/F? I/�,-LR�CJZ/ ��y!/L . LOT NO.
RNO TRHTTI�
A7 1962 ;ON FOR GAS PERMIT
UG 3 0 OF CUPERTINO a
.
Dat yyr SO t91�v L Permit No.
' h lrI f I Ur LUNERTI thll Fee S '3.A C)
Application is hereby made to the City of Cupertino fora permit to install gas pipes
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 laws applicable thereto.
Use of Premises, + G.
h Owner I Address✓ "' ��
By I Address IIPVdP
CONTRACTOR, AGENT I
Phone[M7--7Approved
ozzl
PLUMBING INSPECTOR
L) m n G)I C
.�,v
F 0�
d � r
z - --------- -- --- ------
m1Y y > 'S1
TFri
— T
'f✓ N
r„ ,�' •JFFICE
hhCOPY
GAS . SERVI6E''tNOT E
BUILDINGINSPE- OR'S O •ICE
CITY OFdER INO
A
' _ /�ry, .•, r., s'6
....:...........:..:-.-`- ./" .....----.. .. ....To
........
T
the GAS e
Owner or Tenant Y ^4`
You are:hereby au' ri to con d
, � ,
At
,�. p-......-
/ New�Service ------------
No. of Meters ---- ---------------. '-T Reconnect- ...:...:..------.-..:.
5 Move'Service
No. of Add. Meters Move Meter ...........................
i �
� LUMBING INSPECTOR �`+J
In 701-50q;-