1126 (2) 0O ^TR T _.
PLIC `TION FOR GAS PERMIT
OCT25�y�p6O �(TY
OF CUPERTINO
Dht�YI�)1II+r1�dlDrnrin, 194 d Permit No.
�f —��—a�Cf1Tf1VII Fee $ I• C5 o
Application is hereby made to the City of Cupertino for a permit to install gas pipes;
'J
0� 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.
u
Use of Premises �•%���
v
Cn Owne & ✓ Address �1
B + cfc ;iJ. &L Address 6` �+ �- ���
CONTRACTOR, AGRI
,,_ Phone V/f/ ';?—.3 zl J Approved S
PLLhABING INSPECTOR
w�.o• � . � � m w^� ro o." .-I R °` �' � ::mow xl � o
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-------------------
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g� GAS SERVICE 'NOTU1, " OFFICE
CC7j )BUILDING INSPECTOR'S qFFICE. ..
PY
CITY OF CUPERT/INO
----------------.---Lr ...... ------------------ 196.03.
To
You are hereby authoriz d to connect the GAS ser ' e for
Owner or Tenant ...... ............... rl. .. ..
At.....,1..9...9�v1....-. � ........
New Service ._.`�....._.........
o. of Meters ........ ............. Reconnect ..............................
Move Service ........................
/
No, of Add. Meters .............. Move Meter --------------------------
................. . ------------------------ ----------------
LUMBING, INSPECTOR
110 1/60.500