2017 1— LOT NO.
D Gs� N FOR GAS PERMIT
EP 1 62
OF CUPERTINO
I
I Date �19� Permit No.
ClT
Of �� Fee $
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 appliance in accordance with the visions of the Plumbing Code of the City
of Cupertino, an 11 other laws applicable t ereto.
v
c
Use of Premises
.-1
in Owner`-cP � Address
By Addressx
t>
C NTRACTOR, A .4T1'.
Phone ! I Approved
j PLUMBING WSPEC
C) z
K W p H 0 b7 7 'tl
ro
-- 9
v
> z -------------------- NZ
— C) o J
------------- E �
� _3
m � ^
• rs.' '1L�-v,• x...k� r. til' I I I a��..r�:,"�• �� ' �� I R