2008 '7(3 U/Q.N LOT NO.
NO. STREET -
�AP,P,LLICATION FOR GAS PERMIT
CIS OF CUPERTINO
ff ,C
SEP 5 1982 LLr1
Date 195_ Permit No.
y CITY Gr CUPERTINO Fee $
- 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
pp and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws //a//pplicable thereto.
Use of Premises &4A k I-.C-A .
wne �'1.2ti.CM.._. Address
By Addres
nn
CONTRACTOR, AGEN
Phone QY — oC �!O Appr' ed
PLUMBING INSPE
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6py
GAS SERVICE NTICE
BUILDING jNsprcroR'S�OEFICE
CITY SOF CUPERTINd
- -------------------- .... ............. ---------
To
You are hereby authorX dd to connect th GAS service I
Owner or Tenant --- . . ..... .
At
------—------
----- --- ------.-----
-
New cc -----4_�............
No. of Meters ..,-/--------------- Reconnect --------.....................
Move
----------------------------
Move Service ---------- -------------
No. of Add. Meters -------------- Move Meter ---------.............. .
............ ---------
61Z PLUMBING INSPECTOR
110 7/61-500
2