2264 (2) d5 ;7''J � LOT NO,
NO. STREET
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APPLICATION FOR GAS PERMIT
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0 J Date••' '. �� 196_ Permit No. a a
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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
i m and/or appliances m accordance with the provisions of the Plumbing Code of the City
z w of Cupertino, and all other laws applicable thereto.
4 Use of Premises
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oa Owner �7 ti ( ✓ Address
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CONTRACTOR, AGENT
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State License --';'-75<< Approved ' '
PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE
COPY
CITY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTIN
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To
You are hereby authoo t� connect the GAS service for
Owner or Tenant
.. - ------.-
' New Servi a .......................
I
No. of Meters ...................... Reconnect ..............................
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Move Service ........................
No. of Add. Meters -------------- o, eter ..........................
............................:.........-
PLUMBING INSPE O Q/
110 6/63-500