NO PERMIT NUMBER (2) LOT NO.
STREET
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
' i'iUG g mo
Date 195_ 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'diereto.
Use ofPremises 14AMILY PLSIDLNCE
v
�n Owner Address
By �UAi1�ING Address
Phone SANTAWCLARA,CCALIF RgIA pp
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PLUMBING INSPECTOR
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^�A BUILDING INSPECTOR COPY
CITY OF CUPrRT a
...... ........ ------------------- 196.1.
To
You are hereby authorized to connect the GAS ervice for
4c>
Owner or Tenant ... e.... .
At ....... .....Z..1::!.....
...... ...............................
New Service ---- ------------------
No. of Meters ...................... Reconnect ...............................
4 move Service ........................
No. of Add. Meters .............. Move Meter ..........................
.........................i k
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PLUMBING INSPECTOR
110 1/60-500