1651 (2) LOT NO.
NO. STREET
® S�APATION FOR GAS PERMIT
p -- Il {,f OF CUPERTINO
Date ' MAY 8 1962 X9195_ Permit No. /W
CITY OF CUPERTINQ Fee $ I
Application is hereby made to he 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 orb r laws applicable thereto.
Use of Premises
r7 Owner_ l��y _ Address
By i_c Address_ _
CON ACTOR, AGEN
Phone_/ — 6;1/ IM Approved
PLUMPING INSPECTOR
a d o o A
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2 A
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017FICE
COP),
GAS SERVICE �N TICE
13UILDING INSPECTOROI'FICE
IN O
CITY OC--CUPER ,��a......... ...... ....__, 196,TS.
To
You are hereby authorize to conned t e ervi o
Owner or Tenant ..
At ..111...6-Sf---- G1 - - -------- ------- ---.,. ......... .
New Service _---4-- ....._......
No. of Meters .....`----..----_ Reconnect
Move Service ---.......... ..........
No. of Add. Meters ........ ... Move Meter
PLUN BINE INSP@CTOR
110 7/6I-500