2187 (2) A&GCy✓�!/U. LOT NO. _
NO. 'AI yy��""��,,
a " PPVIf�'ATION,POR GAS'. PERMIT
i — t CII; CUPERTINO
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3 a Date ( , 9 19p6�ys��i, Permit No.
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1, 0 Application'is hereby made to the City of Cupeftino for a permit to install gas pipes
o a and/or gas appliar ces.as-listed op the-reverseside-hereof, and agrees to install said pipes
>• and/or appliances in.,accordancewith the:,provisions of thc�Plumbing Code,of the City
a w— of.Cupertino; and 'all'o'tiei''laws.applicable Fheeto.
g a' Use of'Premises''
o1.4 3rOwner"'
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CONTRACTOR, AGENT_r
3 m : $hon U 7 3 �/7 E` �. 'a .,f�
u s State License �-3 Ap rov
PLUMBING INSPECTOR l'
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OFFICE
COPY
GAS SERVICE NOTICE
/ BUILDING INSPECTOR'S OFFICE
CITY OF CUP ERTINO
............. J........ ..//.......................... 196........
To
You are hereby a"ed ed to cod ect the.G r "
Owner or Tenant .. .. :_v.....................
At ....../. ? ............ ........ ........
New Service`:. /--------------
�No. of Meters -/............... Reconnect ..............................
Moe 1Nr ° ,
No, of Add. Meters .............. Move Meter ...................... i
Y
` .......... ... - -- — .........................
PLUMBING INSPECTOR
110 7/61-500 ' Y :tea ' 7