2015 (2) TR'R
®d APPL7�IC ION FOR GAS PERMIT
I SEP 17 966 OF CUPERTINO
&T'NO Iql!�a Permit No. O �J
Fee $ •S 0-0
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.
Use of Premises
17i Owner ��-w Address
By �' - << � Mme, Address SCnc��
CONTRACTOR, ENT '
Phone Approved
PLUMBING INSPBC R
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OFFICE
'COPY
( GAS SERVICE NOTICE
$� r- ,�p r
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO n
---------- ---- _- .......... .........._., 196-c�
To
You are hereby' autl fzed t con e t t GAS(1Crice fo
Owner or T /
//enant .4�� }
At
New Service
No. of Meters ......C-<......_-- Reconnect _..........
......
I
Move Service -.
No. of Add. Meters ---------- Move Meter ...._.._........__....
eg
-----...-- - ------ .. . .....-----......---
PLUMBING INSPECTOR
110 7/61-500