924 (2) LOT NO.
NO. 5TRC T
APPLICATIOI�IN} FOR GAS PERMIT
�1v1AR 9- 196% - F CUPERTINO
Date t ,1�7 Permit No._��
G1 I Y Ur ! t
Fee
Application is hereby made to the City of Cupertino for a 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 oth r laws applic thereto.
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aUse of Prem' _ —
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Own
e Address
BY— Address `'
CON ACTOR, AGF.N}�
Phone — z.3 ,Z Approved
PLUMB NG INSPECTOR
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�� �(� GAS SERVICE--NOTIC
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BUILDING INSPECTOR'S OPFICC
CITY OF CUPEiRTINO /
..._-------•-------3//. ...................... 940
To
You are hereby authorized to connect the GAS service for
Owner or Tenant ... .�S.�:G'.( T,r/+. ... ............ .. ....... .... .... ........................
At ........
New Service .....f.'
No. of Meters ...... Reconnect ...-....
`f Move Service ........................
No. of Add. Dieters ...... . Move Meter ..........................
........ ................................... .....
PLUMBING INSPECTOR
no 6/59500