491 (2) LOT NO.
NO. SMEET-
APPUqATJL0N FOR GAS PERMIT
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J�CC�� ERTINO
Date ate+ C[�n(�95 Permit No.
(/����TT (n'��C Pee $ Z S
(� Applica68hlihet mQJI°1L`li hj'YY6 Cupertino for a ' to install gas pipes
\r\ and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
V\ and/or appliances in accordance with the provisions of the Plumbing Code of the City
'of Cupertino, and all other laws applicable thereto.
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Use of Premises
7 .Owner <(� oa L/rte C _�s�Address�/ . v��l�1
BY—V. L. HICKEY 3nM4 wn I Address
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P. CCgWACLrOR,r�TGP.NT 1
Phone $unn 1 rte_ Approver
I i°' 1=�1--�. svl:-�• 1 I ! I 1 I 1 I PLUMBING INSPECTOR �:;�l '
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GAS SERVI'OE NOTICE•.' °oPCE
BUILDING INSPECTOR:&OFFICE
CITY OF CUPRRTINO
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To. . ' p
You are hereby authorized to connect the GAS service for /J
Owner or Tenant . a2�1..3R--i G!" 1. 7s...f.3_._.4%51....•....................:......_, -
Atd.�.Z.. .�. .�..:.. .... /L
. .IVew, Service..:_.........----[.......
..No. of Meters.:............`..`.... ' 'Reconnect
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Move'Service'."..:................a ,
No: of Add. Meters .:..:---:--;• , Mo e Metev.:: °.. -.:.-.... .
....
1p PLUMBING INSPECTOR'
no 6/59.5no