2016 (2) ':)-- -z� K\C- C-[' tL� tOT NO.
NO. MERT
fVjQ1Q- A N FORGAS PERMIT
CUPETINO
P 7 1962
Date 1-2+ 19N Permit No.
CITY OF CUPERTINO Fee $ �tU
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 other laws applicable thereto. i
Use of Premises-
Owner
reemises Owner `�_ � Li/_ Grc Addres
By ZZAr�/✓u�ai+ �c a Address "WSPICTO
CONTIYACTORAGENTPhone �.� C: ' ;T RApprovePLUM
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OFI7ICE
COPY
GAS VICE NOTICE
BUILDIN INSPECEOR'S\('OF-FICE
CITY OF CUPERTI&
To
You are hereby auth to onn the GS=
mc
or Tenant -_.... __.
. ..............
At . . .. -
/y New Service ......-----.--
No. of Meters -dam--------------- Reconnect .. ....-......
Move Service
No. of Add. Meters .............. Move Meter
-------- ...-- ---- ... _.'---
PLUMBING INSPECTOR
t10 7/61-500