1086 LOT NO.
NO. STREET
APPLICATION ;FOR -APPLIANCE PERMIT
CITY+ OF CUPERTINO
I Date o2.'-.. 196.4 5
�J Permit No. a �P
Fee
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Useof Premises
Owner d v�"�� _ ' Address
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B Addr
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PhoneGcw'�� ;I Approved
PLUMBING MSP8CT00.
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OFFICE
GAS SERVICE NOTICE corn
J BUILDING INSPHC'POR'S OFFICE
CITY,OF CUPERTINO
... .......
9
................................................serfo
To You are hereby autho d to e
ct e GAS service for
Owner.or Ten ............................. ... ...............
At ................ �.Q.�.
• New Service .--_.
No. of Meters ... -.' • '
. .~ Move Service ........................
No. of Add. Meters ...... PBN
er ............. ............
.. 4 ................... . �
PSPECT
110 7/61-500