1510 J O LOT NO. /
Fy B
APPLICATION FOR GAS PERMIT
rDEC 5 1961 OF CUPERTINO
Datep,_-rYOF
MO195_ Permit No. /d�c/C)
Fee S�
Application is hereby made to the City of Cupertino for a permit to install gas pipes
pQ and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
Do and/or appliances in accordance with the provisions of the.Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
v
c
Use of Premises
v
Owne _ Address
By Address
� Q C TancTOa, AceNr
Phone ��I - /9 0Approve
PLUMBING INSPECTOR
n C1 z '�`. m tn� � ti� � G1 tr1 f1 G)� 6w
a
-- -- _----- -- H.
r O
^
� E �
' _ _
m n n (1
• n i' � ' -
as OFFICr
GAS SEWC-C OTICE core
BUILDING INSPECI'O 'S OFFICE
/ CITY OF CUPHP TINO
- - ---
_...---
�l_..--. ------- ....... 19G.�.
To
You are hereby aut orized ta c ectthe GA ervice
Owner or Tenant -. ----- �_
At 16
/ New Service ...4�._...._-_...
No. of Meters -_.L... ..........__ Reconnect
Move Service --_ .... ..... ........
No. of Add. Meters .............. Move eter
UMBING INSPECTOR
I10 7/!]-500