144 (2) ..no. staeer
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date 196.0 Permit No.� _
Fee $
®G �(: s eree City of Cupertino for a permit to install
gas ap Fsl lispd on the reverse side hereof, and agrees to install said
\ ' appliances in accordance wi. h��7tT.tpA sons of the Plumbing rode of the City
of Cu �t{upg apd[all 11L��fadkh�p�I ble thereto.
Use of Premise's
45 Owne f Address
I /S�P�6ifj• I Addr i �T
.. CONTRACTOR;AGENT -
Phone ;> Approve ✓
iPLYMEING INSPECTOR
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GASS. RVI `E NOTICE ° }F
BUILDING CTOR'S�OFFICE
CITY OF C ERTIN
........................... . . .�.....................................
To _ .ft
You are hereby authorized to connect th AS service for
Owner or Tenant ..!..v� ✓GO�Q�.��GC/
At ... ........
�. .
New Service --i!7".
r
No. of Meters ..... ................ Reconnect ----------------
Move Service ........................
No. of Add. Meters .............. Move Meter
... ..............�................................................................
/<�AUMBING INSPECTOR
7 T 6/59-500