2554 (2) } 7�clZI rY, 1�'v`O�lG.al,'�S �i.VCY�AA9�LOT NO. 1
NO. STRE T
APPLIC 'TION FOR GAS PERMIT
z a D OF CUPFRTINO
W Z SEP 9 1963 � ) _
xo S�
3 a Date 3 196 Permit No. /
=LL CITY OF CUPERT'^'^ Fees t sb
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o W and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i < and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other laws applicable thereto., ,
w x "
J LL Use of P emises
� 3 Owner \Vy� .L�SVYICrVtG AddressZ u1''A
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_ ac T"A Q vim;'��s V
ddress F6
CONTRACTOR,AGENT ♦v."
— m Phone
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uf State LicenserspproveL " Z�o
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PLUMBING INSPECTOR "'°';
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GAS SERVICE NOTICE OFFICE
BUILDING INSPECTOR'S OFFICE COPY
CITY OF CUPERTINO
................... ............ ............................ 19
6.
TO
You are hereby authorized to conned the GAS serMvifor .......
.. .........
Owner or Tenant ...... ... ....
At ......... ........ .. .......d ...
...........
New Service
No. of Meters ........ ............. Reconnect...............................
Move,Service ............. ...........
No. of Add. Meters .............. ove Meter ..........................
Meter
... ... .... ....L ...........
A7PLUMBING I P CTO
110 6/63.500