2178 (2) 2 • t.oT NO.—
SAP
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N . sTKPH't 119 lr'
APPL TION FOR GAS PERMIT
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< !FES Y a � ti PI'�-OP CUPERTINO
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0 U Date K r?-�rrr RTJlVt2:: Permit No. �( -7O
= o !// Pee;d�
Application is hereby made to the City of Cupertino for a permit to install gas pipes
o` and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
a 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.
J LL Use of Premises
00
3 OwnerAN/ lC f— Address-5-44- /V cF
zzo By f7�G rG �i cnox�ceT:arr Address .S'— %V
c mz Phone =/S•a'•$���`1�
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02 State License Approved
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n L1 � � ynt_nnro � L) mnG'1EC�
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CE'RTfFICATE ;.OF ' CgNPLE•TION
,,BUILDING INSPECTOR'S OFFICE
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CITv bF"CUPERTINO
�a
........
� . . ' 19-L� � Building Permit No 5``..j.. j.
C..L�......
The BuildingLocatedia �.�
� �...... :. `� .._'6t�L;:q;,gC,;��..d...+.!')!' f
Owned byc ^-:'::-. .. Se�,t.� ?�....
(Completed) �` p t'f' '
Has•Been4 Altered)
fol Use As: ..........G .t" ..... . '<L4 a.(.. ...........................
...........................................................................................................................
'.'• `(
{ ..
... .......... \rl...�...............W.. ..�....... ..........
BUILDING INSPE OR
102 1/63500 y,�
OFFICE
GAS SERVICE'NOTICE COP),
BUILDING INSPECT'OR'S OFFICE
CITY OF CURERTINO
.............................. 196.
To 4
You are hereby author e t c the AS service for
.. ..
-Owner or Tenant ........... act�
.... ............ - -- ------------ - ---- ------ --- - - --- --------- - -
At ..................C
............. .. .... -- -
- ---�11—
New Service ......
No. of Meters ...._................. Reconnect ..............................
M e Service ........................
M
3e
No. of Add.,Meters ............. ove er ..........................
ove
.... .... ................... ..........
110 7/61-500 k, PLUMBING INSPEX