1501 LOT NO.
NO. STREET (//l
kPL ATION FOR GAS PERMIT
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��.� �F CUPERTINO
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' Date s 19fJt :93� Permit No.
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m ��// ((��[ �� RR �� Fee ,$
ApPIITL t9•�ere�hia�'tbTtNe ity of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof nd agrees to install said pipes
and/or appliances in accordance with the provision the Plum Wng Code,o the City
yy of Cupertino, and all other law applicable thereto
Use of Premi
u
Owne Address
By Address �07a r ' (fir 1
�; Q CONTRACTOR, AGP.NT
��Phone l(�—j- 0 Approved
PLUMBING INSPECTOR
d y O I
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I I IRS
GAS SERVICE NOTICE OFFICE
COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CU NO
To
You arc hereb- guthorized to w i ect ie. .AS service Cor
Owner or Tenant ... .. --. .-_.x
At ..... d...7..7...0. .. ..... ......... . ... J��'
New Service --------------- _.....
No. of Meters ...--------�...._.... Reconnect -------------
Move
--Move Service - -------------------
No.'of Add. Meters .............. Move Metcr ...-
PLUMBING INSPECTOR
110 1/60-300