1994 �I ✓ ( ( LOT NO. /
NO. STREET ;
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
Date �— Z c� 19j z-• Permit No. ✓ 9
'
Fees
Application'is.hereby made to the City of Cupertino for a permit to install,gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
�i Owne Address f �r
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CONTRACTOR, AGENT ;al
y" Phone lJN7 3 y7. 4 Approve
T.
PLUMBING INSPECTOR
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OFFICE:
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GAS SER, NOTICE . .
BUILDING IN FFICE
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CITY OE ,�,yI, O
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_•.,.',;• You are hereby aut r' to conrgct the G s rv' o/rl�
Ownef`or Tenant .... - . . . . _ ...........
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No. of Meters ". Reconnect ...............................
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No. of Add: Meters ::............ . r Mav , eter......: :`.:,.:---------
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PLU NG INSPECTOR
•0110.7/61-500 v6 F•� �:'