2276 (2) LOT NO,
NO. STREET
APPLICATION FOR GAS PERMIT
z i CITY OP-CUPERTINO
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3 U Daze 196x! Permit No.
F0 Pee'S �/ S
Application is hereby made to the City of Cupertino for a permit to install gas pipes
°o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'z m and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
w Use of Premises
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CONTRA OR,AGENT
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i o tate Licensea0J " l !?e Approved
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TEMPORARY GAS SERVICE
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OWNER: .......
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LOT: _--..../.... .............
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REASON:
The der' ed a es to be responsible for the gas service at the above location,
until the it n eady for occupancy, and is released-by the Bni ng Depattrnent,,,
City of aper i4W-#?
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(j R TENANT OR OWNER /
71N 1/63-500 �. .lb's. 0 `