2188 (2)J� LOT NO
NO, rSTBBB
N < � �APPLI - TIOM�N5 FOR GAS PERMIT
z — i UPLRTINO <-.v
fo �FEa.2a�as�, CITY OC �C�f,:,,
° a Date /�o/Z'- ../ r,'.:. 6�i3 %,'Permit NoiC_
dLL Y CITYIAz I,� — - Fee•$ ;
0. lApplication is hefeb} maoe'to the Cityrot' ' ertmo fora permit.to install gas pipes
Ip and/or gas appliances as.fisted-on-the.reverseesiderhereof; and agrees touinstall'said pipes
>.� , and/or appliances in-a theaProyision; oF`the Plumbing Codeloflthe City
z m of Cupertino, and—all-ot e�laws,apphfable.flrereto.
a n. Use of Premises...., ' ..J^• M;' ._r - -
00 /
" a , Owner AddressUlG L
z-i�(\
z ByA'ddressp
� 0AGENT'
•3 � .
- w Phon i ,.• ,w • .
1w z
� State License ` Approved
777 P
t
V
s6r�
Jo', .J
You are hereby
Owner or Tenant ....
1.
At............
` oPP
GAS SERVICE NOTICE
COPY
BUILDING .INSPECrOR;S' OFFICE
CITY OF. CUPER
:.... _ �.
xuthzed to connect the G� service .foY1
r /1 lop
No. of Meters ....................
No. of Add. Meters ..............
1"
New Service'y....._k��.....
Reconnect ..............................
Move Service ........................
�MOe Meter ........................
11, of lel 1'
...... ` .a...
PL
.r--. ..UM[
110 6/63-5011