2114 �/J I
LOT NO.�
NO. �STR EET1 `_
N �rP R1 XbON FOR GAS PERMIT
z i CPCY:'OP CUPERTINO
x �IDEC 6 1962 ;
3UDate ITY (� /+ T 1n96— Permit No. v`/(
LL9 9t dfi�� l'��P 1 � U Pees
° p i ati is here Y e to he City of Cupertino for a permit to install gas pipes
o a and/or gas-appliances as listed on the reverse side hereof, and agrees to install said pipes
i w 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
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o a Owner i �4st,�_�26 A. ..i" Address
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aoState Licensey�� Approved
-t) CONTRACTOR. AGE T
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OFFICE
GAS SERVI E NOTICE COPY
BUILDING INSP CTOR'S OFFICE
CITY OE PERTINO
To
You are hereby authoriz to connect the G rvice for
Owner or Tenant .-......... �j ji p
/ n ._.._._.---
At ... .1. �`-- ---- _.-- ---...`- -- -- --
New Service ..L—...............
No. of Meters ----/-------_----- Reconnect
Move Service --------------- --------
No. of Add. Meters -------------- Move Meter --------------------------
----
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LUMBING INSPECTOR
110 7%61-500