363 (2)NO. • STaRRT
sv APPLICATIO JFOR APPLIANCE PERMIT
CITY OF CUPERTINO--
Date, 19G..... Permit No.
Q
:\ Fee f
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 slid
!' appliances in accordance with the provisions of. the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises �+
uq i
r7i Owner Address
By -a • Address
CyyNTRAC3*0R, eNT
Phone4_' (� / // �' APpro
LUNRING INSPRCTOR
7_
Gr
nry�
N
OFFICE
r ZOFY
GAS SERVICE E
BUILDING INSPECT IiIC
CITY OF CUPERTINO a
7
.............. .. .....
To
You are hereby author to connect he GA ice f
�ori!e
. --.,•* ................
Owner or Tenant .... ...... ..
; a, ..........................................
At ... .. .........
New Service .... .......
No. of Meters ...--1.............. Rboonnect ..............................
Move Service ........................
No. of Add. Meters ..............Move Meter . ...... ...........
LS.............
BING
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110 7/61-500 -t-A