975 (2) LOT No. �O 2
MAY 16 194"OP4CATION FOR GAS PERMIT
�/ (� CITY OF CUPERTINO
q'I' U; CUPE 19y4 Permit No.
Fee —
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—_--L
�i Owner ,�BaiAddress
By JoeA� maral PTuOng, nc— Address a
CONTRACTOR,
AGENT yJ /
Phone_�r�.391i Approved W
PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE,
COP),
C) i BUILDING INSPECTOR'S OI DICE
CITY OP CUPERTIjV0
To
You are herebymrth iz d to connect the GAS s ce for
Owner or Tenant ---.... ..._�"5.��—�-.._•�
At ....... ............... ...._....._.................. ........... t:<..:'_.'.--------- ..............................
New Sen•ite ......__✓........
No. of Meters ....._./............. Reconnect ..............................
Move rvice
No. of Add. Meters .............. 4oi Meter ..........................
PLUMBING INr)(
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110 6/59-500 ((//