1268 (2) 35Z• /?1/70 I _. - F LOT NO. el
NO. STRRRT
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date i'! 6 196 196..:,. Permit No.�_
Fee $ r�O
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 code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
n Owner J isf %1 e m.c J _ Addresses
By Address
ACTOR, AGRNT
�1G &+SHEET METAL CO. Approved �t
Vb 180 E., CAMPBELL. CALIF.1 MBING wsaeCToa
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�1 GAS SERVICE NOTICE OFFICE
UI
./. COPY "
LDIIYG INSPECTOR'S OFFICE
l� ITY OF CUPERTINO
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You ire hereby authorize t ,tonnectthe GAS service
Owner or Tenant ...._....._.... ..._....---- ........�'t�-ad_....L.� -------------.
At ..:.._......_t.a... 1 O /
New Service .......!/...........
No. of Meters . 9...._....... Reconnect '
okeet&
........................ '
No. of Add. Meters ......._..... p . "._............. .. - - .......... .....PLUMBINGO
Ito 6/63-500