122!�(0�3 U/I//✓its-i vL LOT NO. V� -+
fCATl01'F0R APPLIANCE PERMIT
OF COPERTINO
Diteg APR 14 IQM� VIMA96..... Permit No.
Fee $�
L 17��1 `I
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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 !-:ode of the City
'of Cupertino, and all other laws applicable thereto. ,
S.
Use of Premises-��-�~4
✓^'�a-
r7 Address
i"-
i
Approve -
1 (PLUMBING INSPECTOR
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(D GAS SER'YIC-E NICE! .� COPN
BUILDING INSPECTOR COPPICE'
CITY OF CUPERTINO
i
19-
To''
You are hereby authorized to connect the AGA/Sse/�7vice for
Owner or Tenant,:...Ao
--%C''V✓�'----...
A-.. //)(.9, ..-% -u se..::�z�.. U..:
...........
New Service .... I................
I No. of Meters
:... /---- "Reconnect
Move Service ...........
No. of Add.: Meters..........:.... .. r '. Move Meter ......................... .
3 . .........C......... : .........................
r. PLUMBING INSPECTOR
..'110 '6/s9-500' - -