2094 (2) - LOT NO.
3 Ci .
ET
APPLICA ION FOR GAS PERMIT
,,����..,,..�'.I' N��O,,,,V 19 1962 c OF CUPERTINO
Dat e�pF__1�AU5_ Permit No. 4C/
vv�t �r �r vv�t f1-f� l "�VV
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
Owner L:;ea 12 c i At1. Addres It
_
ByAuc S d10 LI me, !J (n Address 1�
CONTRACTOR, AGBAGB T _
Phone9 e 1 7 4 Approved/
-� PLUMBING INSPB 'O
rt L) z
m O
w o O a gymy(( n c c. �'y n° n' coo
M M Q d n 9 F n [ D h GO O w ^ 'D
v N .G. N Y � ^ a, � n N w•
v
m y a rB
T -
--- I z
w E �
—IT I -
m �^
-COFOPYFICE
GAS SERVICi NOTICE
BUILDING INSP�TOR'S OFFICE
CITY OF CUPERTi N 0
-------- ------- .. ....... .....
To I96..
....
You are hereby author' ed to connect the G servi
Owner or Tenant
At — - -2)/
----------------------- ----- ------------------ --
New Service (��
............ ....
No. of Meters ... ............... Reconnect ---------------- ------------
Move Service ------------------------
No. of Add. Meters ............ mole Meter ................. ........
Move
----- -----
PLUMBING INSPECTOR
110 7/61-500