2185 (2) LOT NO.
STREET, -
APPLICATION FOR GAS PERMIT
i.a'rc
'CITY OF CUPERTINO C
s -
Y 0
a Date
Ox - , y
3 1962
T Permit Nor
Application is hereby'made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
> and/or appliances ifs=atcordante with the provisions of the Plumbing Code of the City
a W, of Cupertino,-hnrj,,gll.oth laws applicable•themutc;.
w x ,
Use of Premises,
00 /�
3
Owner-64& 5-� Address
i
z zByl/�l Address
CONTRACTOR, AGENT
3 ` 0 IV 7 — 3 'P 7
— m Phone
< a State License Approved gs�3 Approved
—U
PLUMBING INSPECTOR
/ ozn
% C) C) = DC) C)
~ , E , u = ■ f
§/ § ƒ)
! ( ± � �%§ ! ® m \/ / 7 (} » %
I.N
Ae 2 c
, [ } �
� { 2
�
GAS SERVICE NOTICE OFFICE
COPY
Cp Z BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTrN ,
.....................L�.. ...-_...�................., I9
To
` You are hereby authoriz d .to connect the GAS f\er>ice oO I .
Owner or Tenant ............... �"' ' 1, .....................
At ...............1..1.Z�..Z....................... �...........a ........ ..............
I ' .
New Service ..... ,
No. of Meters ........I............. Reconnect ..............................
Move �ervice ........ ...............
No. of Add. Meters .............. Move Meter ..........................
........... ............ ............ :�..................C..
i� PLUMBING INSPECTOR
110 6/63-500 - • -