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APPLICATIION FOR GAS PERMIT
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° Application is hereby made to the City of Cupertino for n pennrt to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'zm nnd/or appliances in accordance with the provisions of the Plumbing Code of the City
Q w of Cupertino, and all other laws applicable thereto.
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GAS SERVICE NOTICE OFFICE
BUILDING .INSPECTOR'S OFFICE COPY
CITY OF CUPER O'
To ........................... �.—.............. 196 .
You are hereby authorized to connect the CA,S service-for
Owner or
At .....�..�....-(.d c�._.._..._1n-. ...._� C�
' J New Service __.....
No. of Meters .........--r Reconnect
Move Service ....._.................
No. of Add. Meters .............. b ove Meter ..........................
110 6/63-500
PLUMBING INSPE� R
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