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APPLCAT ON FOR GAS PERMIT
-M a I OC CUPIRTINO
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a Dat 196_ Permit No.
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PERTINO
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o Application is hereby made to the City of Cupertino for a permit to install gas Pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'zN and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino. and all other laws n plicabte thereto.
0 a Use of Premises
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EPA TEMPORA �Y 'GAS SERVICE'
FEB 9. 18 63
DATE: ------ ---- ....... ........ Fee: .........................
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REASON: .....
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The undersigned agrees to be resp ib the gas; service at the above location,
until the building is ready for occupancy,
Cit Of Cupertino. panql and is released by the Building Department,
Phone ...
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17 1")MGO INSPECTOR Ef OR OWNER