2189 (2) LOT NO. G E
NO, STREET
N �aA`PPLS CATION FOR GAS PERMIT.
z Z �� �'''�Q- TCI I OF CUPERTINO
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U Date 19G Permit No.
LL W Appl ahonlls hereby mad'elto�the City of Cupertino for a permit stall gas pipes
to < and/or gas appliances as listed on the rererse side hereof, and agree's•to install said pipes
Z N and/or appliances in accordance with the provisions of the Plumbing'Code of the City
z i of Cupertino, and all nth r laws applicable thereto. . n �� ,t
„ Use of Premises
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. 3 Owner Address
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0 CONTRACTOR, AGENT
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u s State License S! s�3 Approved
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PLUMBING INSPECTOR
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OFFICE
COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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TO
You are hereby auth 50' o connect thZeGerv' eiz ,
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Owner or Tenant ......L-&?OOZ4
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.. ........ ....Q-4�------------------------ ...........
New Service ----
. ... ... ...... ....
No. of Meters ..../....:.--.--- ' Reconnect
..............................
Move Service ........................
No. of Add. Meters.!............. Move Meter ..........................
----------- -------- ..... .....
PLUMBING INSPECTOR
i in 7/61-5oo