2083 (2) I v`` �G+I-ll) � � �n�OT NO.
1 l• NO. MEET
S,A.,Ps,`PLICATION FOR GAS PERMIT
z i END
/�. `t*. ITY"OP CUPERTINO
x0 I ,'
0 < DatC
U q � 7 � Permit No. '7����J,
i a Fee'$—
o A 1'rn 'onpp'sthereby r�gd�[q ghg�ity of Cupertino for a permit to install gas pipes
O < and/or�A��i pli'dtSms asl�i felsnit6�'Iteverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all 1 r lawZle thereto.
w x
r Q�
0 a Use of Premises
o0
> ui
3 Ow er Address
oa
ZAzJ (�
z Address /
J 00 011' 41A
w Z
0 a 11 Z �� Approved .�`i.'z/,
o 'tate License�
_ U
CONI'HA II ACF '1'
« \ � ƒ \ • \) \ ! ` ] , ! [ 2 } /% .
% \ \ (n7,3
; } § ` 1a
-- /
\ 7 /
{ E
� � r
me
/}
{�
TEMPORARY GAS SERVICE
D -- ------ ------- Fee: ----- ---------- ---- - -----
FO
F R,.
.j it _ .__ ___ _
lslut;t-,
T: ---/ 0.'3J01...&---- 0-.*...,-
CITY 0( CUPE-tWh
LO
,;� ........e-,. ------ ----------------------- ------------
R
REASON: ..........
nd gas service at the above fixation,
e undersigned agrees to be responsible o the
(intitthe build' d f
iijg is reads, or occupancy, and is released by the Building Department:
City rti o.
4-- 1 i Phone
-- - --- -----/ ------ -- ------ -- TENANT OR ----------------------------
INSPECTOR OWNER
SPE
117 1/6MOO