2177 (2) p'ZIDt 1 I IAT No. y3
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APP L'ICAT�ON FOR. 'GAS PERMIT
i i 11OF CUkRTINO
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3 w LL J . .-. 1 . `N(196Permitll— •toe.u
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� Application is hereby made to the City of Cupertino for n permit to-install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
,ZN and/or appliances in accordance with-the provisions•of the Plumbing Code of the City
a W of Cupe'r'tino, and all other laws applicable thereto.• - -
j a ,Use of Premises - -
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Adress
`Q OwnerlS o �1L ( co i lz
(( .:h•y ry'
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J o y� 'CO 'OR,AGENT
< a 'State License I Approved b
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_......•--•'*"'�r��«,< _ ,.icy ,. PLUMBING INSPEC7 R+..
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OFFICE
• COPY
GAS SERVICE-NOTICE
't BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
19
To
You are hereby auth Ulo necttOwner or Tenant ._..--.-- ......-'--............. .._..............-. .-----...
At ............. ..1.1 J............: �xl.V........ ---
New Service ------°%......
No. of Meters ........1............. Reconnect ..............................
r
Moe Service ........................
. � No:of'Add. Meters ...::.::.....� .' '.�, , ''1M a Meter ..........................
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PLUMBING, SP CTO
- - .. I ILZ61-500