2355 OHO I. {WRT� LOT NO. y/
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APPLICV TON FOR GAS PERMIT
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3 u Date /� IUPC nl9G- Permit No. t:23
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'- Application is hereby made to the City of Cupertino for a permit to install gas pipes
0 a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
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Use of Premises _ /a��0,l1. /ll�PQ4Ca
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Owner Y/_�lJm/Y J� J(A � Address 'LGaQQ
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3 r y ONTRACTOR,AGENT Address
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WW / WILLIAM D. BENEVICH
0 State Licenslo(a -��y��s T i Approved
�kPLUMBING INSPECTOR
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AS SERVICE NOTICE OFFICE
S9 BUILDING INSPECTOR'S OFFICE COPY
----—------!- CITY OF CUPERTIty_ , �
----- - ---- ------ ......... .. .. .. ........ .......
To - ---
You -* ** ---* ... . ... ..... 196�
You are hereby authorized connect the GAS se 'cc for
Owner or Tenant ................. .... ... . ...... --------- .....
... .. ... .. .... -- ----- ...... .
-p—----------------
-
----
At ....................
New Service ----
No. of Meters .... ............... Reconnect ..............................
ve rvic ........................
No. of Add. Meters .............. e, r
.......................................................... . ........ .....
PLUMBING INSPE -
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110 6/63-500