1652 (2) LOT NO.
NO. W�EE1�
D � L
APP.LICATI PEES ;FOR GAS PERMIT :
C1iFiiCUPERTINO
APR
Date2 b 19Irl IRV � Permit No.�� '
I �!1 1141 o0
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.
v
Use of Premises
Cn
Owner O/i/.� e��!// Ly�C/ Address
By -2/�!CONTt�ACTO
y / i Address aoo
_ , AGENT IPhone �_S Approve
' �. PLUMBING INSPECTOR
G1 Z
o n ro n
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OFFICE
► '' GAS SERVICE NOTICE copy
BUILDING INSPECTOR'S OFFICE
/ ///• CITY OF CUPERTINO
96.-Y _L..... .. .f. .z. .�1..._............. 196---
You
ou are hereby aut or d to connect the GA se rice for
Owner or Tenant .._........ .... ...... ........`._.At ..... 1- —
..
New Service _ ....-
No. of Meters --- ..._.. , Reconnect ...:-------...----...
. .ter` Move Service -------------..__.
No. of Add. Meters Mov eter ....
a
. t
I '. 1 � � PLUMBING INSPECT
�.l 10 7/61-500