1005 (2) /q 7 10 --.,L LOT NO. /O
APPLil�ITY
TION FOR GAS PERMIT
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UN 2 ' 1960' OF CUPERTINO
LSII; CU
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OF
nnr191_40 Permit No.
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Q� Fee 3 i
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.
c
Use of Premises
,)5 Owner _ Address
By ( p HPI PIUMbillg, InG Addr 5
CONTRACTOR, AGENT /)
Phone Approv d
PLUMBING INSPECTOR ` /
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GAS SERVI PdOTICE COPY
COPY
FICE
BUILDING INSPEC OR'S OFFICE -
e�/ CITY OF CU ERTINO
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To
You arc hereby auth zc to connect the CAS scrvise for
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... ......... ......_.------.......---.. _.......... ... ...........
Awncr or.. C17n7............._...m-L2L"2.� }. .�Z.�. .Q.........................
...............- New Service ........
--------------
No. of Meters .......... ---------- Reconnect
Move Service --------------- --------
No. of Add. Meters .... r- 2zgQ
T.. ._:....PLUMBINGINSPEt
110 1/60-300 l�JI