1292 (2) Q \r rz h s S c1/ LOT NO. /
' NO 0
D M APPLLII N FOR GAS PERMIT `
APR 4 10 OF CUPERTINO
Date,,,.w� �n1r!bl'0 �/- Permit No. �o7 ,
� I RR�� ����``1hVV Fees 4 6'0
(� 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
Owner Pj�i�.- " Addre
AddressByer—� i�uss y'CONTRACPhoneUV7—342Appro
PLUMBING INSPE O
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GAS SERVICE' NOTICE Q% OFFICC
COPY
BUILDING INSPECTOWS, OFFICE %,W-
.1
CITY OF CUPERTINO
.................... ................. .......... 1961.
TO
You are thereby authort do to connect the GASt jervi..
n �ce or
0
, � 4��
Owner or Tenant . . .........
.. ................
At....ell�. ..... ... ...... ............................................
New Service
..........................
No. of Meters .... ................ Reconnect ..............................
Move Service ....................
No. of Add. Meters .............. Move Meter ..........................
............. ,--Jg:;;l::;:::;�
............
�ZPLUMBING INSPECTOR
110 1160-500