1593l, 64A LOT NO
D R GAS PERMIT
YMAR 3 0 t F, CUPERTINO
Date— Permit Permit No. Z
I Fee $ P, 2u
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.
Use of Premises!
PLUMBING
of Appliance I Units Fees
Gas
Miscellaneous
NAME TYPE
Inspected and Approved ------------ =---!.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets , I Size of Main
Gas Piping Fees
Tested and Approved .. .e?./...I........
DATE INSPEC[OR
OFFICE
COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
.................... ......................
TO
You are hereby auth d o connect the G ery cc for
*,7
Owner or Tenant ...... 41, ........ . .. ............ ... .. .. .... .... -:n ............ ...... ...........
At..... /Z-- .. — --- -- -- -------- -------- ... . . .............................................. ........
New Servi' cl—�
Service --------------------------
No. of Meters .....l .............
No. of Add. Meters
ilo 7/61-500
Reconnect ..............................
Move Service ........................
Move Meter .......... ...............
...... .....
PLUMBING INSPECTOR