746 (2) NO. STREET
0&91 1 APPLIANCE PERMIT
C F CUPERTINO
62 6
Date """" 4 196--... Permit No.
CITY OF CUPERTINO Fee s I J�
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises .IA�u_-
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wner Address -
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By _= I - Address_
R GENT
HEATING & SH€ NfffW C6.; A roved
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18o 1'$HtThI TAKI6 AYE.; GAMRBEEk, fANf. P�UMRING INSPECT
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OFFICE
GAS SE Vlti .NOTICE . .
BUILDING'^NSPEC'OR'S OFFICE
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F.-CUPERTINO ,
To
You are hereby aut ed tnect.t e G S service for
r1xG+�1�
Owner or Tenant
New Service ---
----------.._......... -
No. of Meters ---/................. - Reconnect ..... ....--....
it,
Move Service .......................
No. of Add. Meters .............. Move Meter ................_.......
.
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' UMBING INSPECTOR
- 110 7/61-500