1298 • C) �-1 I 1 0- UZ 1`-S S LOT NO.
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® "L DVION FOR GAS PERMIT .
APR 101961 TY OF CUPERTINO
Date �— 1961 Permit No.
CITY OF CUPERT Fee 2.
Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
(n and/or appliances in accordance with the provisions of the Plumbing Code of the City
"C of Cupertino, and all other laws applicable thereto.
Use of Premises Jai^ wP t
17i Owne ! D Address _—
By 2 Address 1tj °`6,1
CONTRACTOR, AGENT
Phone V& *)— 3417,2APProve-T `
PLUMBING INSPECTOR t
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