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2181 (2) OT NO. NO. trq 1 IO- APPLICATIO,N FOR GAS PERMIT J FEB 2 5 11963 CRr,-OF CUPERTINO ,, � Date g ,I`795�.iz Permit No.___C'^^u"/ CIT r c -1 Fee ,S V d L a 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 f and/or appliances in accordance with the provisions the Plumb' C��e of the City �3 of Cupertino, and all other laws applicable thereto �a — v Use of Premises r u In Owner_ Address A'BL LL By P///r'D y //,L l//Y,.9/ntb Address ,d'GL CONTRACTOR, AGENT Phone 7rE— E//l Approved PLUMBING IN5PE(7cOR z — -- --- -- -- -- '" T _- ------- — __— ---- -- � z � 3 w m R n w A A I I�� OFFICE GAS., SERVICE NOTICE AoV, BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO To You are hereby auxtw;z�� vice for Owner or T ant ..__ .... O ........... 1 New Service ----- ..✓....— No. of Meters -._.L. --------. --- Reconnect ...... Move Service .. ._ No. of Add. Meters .......... ... M ve Meter - --------------------- PLUMBING IN EC OR 110 7/51-500 a TEMPORARY ' GAS SERVICE DATE: ---------------- Fee: ------------------------- OWNER: AT: LOT: ...... -------zt-m�.. .... ........... . P,Pv...k REASON: ....... The undersigned agrees to be responsible for-the .iblTYT-UPERP-NI(I" gas senice at the Mve location, until the building is ready for occupancy, and is released by the Building Department, City of Cupertino. PhoneX ------- --------- - -------------------------------- -------------- - 717 1/63-500 INSPECTOR I TENANT OR OWNER