2656✓Lul� C/i' LOT NO. /1
APPLICATION FOR GAS PERMIT
DEC 19 1963CLTYj OF CUPFRTINO
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Datcl _ � , 1 19b L-% Permit No.
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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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
:a Use of Premises
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Owner Address /(7L'/D
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GAS SERVICE NOTICE OFFICE
D a/� COPY
/✓�//pt'j BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO ry
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You are hereby authorized to connect the GAS service for
Owner or Tenant .Lp�`,....... .,—_��/. -..--................__......_...._....._.
Atr�i.��oZQ....:...-^Gf�GZE�L-.-....._......_....._..._..............
New Service A. ................
No. of Meters ............. Reconnect
..............................
Move Service ......... _._........
..
No. of Add. Meters ...._....... Move Meter