1576 (2) z/ +� LOT NO. &:
No. 'APeT AT1 N FOR GAS PERMIT
IMAR 27962c1lffZF/CUPERTINO
Date.,(SX` 19t>ZZ Permit No.
l+� ® 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 oth71aplicable thereto.
c Use of Premises
Owner� �c�/ � Address
Address
,! CONTRACTOR, AGP.N
Phone �Z� I Approved
1 PL a1NG INSPECTOR
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GAS SERVICE NOTI. E
BUILDING INSPECTOR'S OFFICE,
CITY OF CUPERTINO
To ...... .. .........._./1/-..........._.._..._..., 196.191—
You are hereby authorizecjo cqpnect the er e for
� % O
Owner or Tenant .....-----_.....-- -
At 4
New Service ..Lr...... ........
No. of Meters ._f.. ........._- Reconnect
Move Service ...._..... ............
No. of Add. Meters .---------.-- Move Meter ...... .........
PLUMBING INSPECTOR
11 7/61-500
M-m T R-71Ri11�