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® 4�i41•pt PSI I AyfION FOR GAS PERMIT
C iTY OF CUPERTINO
#�' NOV 1? 196
Date Z 1/0 1963 Permit No.
C! T U E a Pee S O
A bb $
pp is here y 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 appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises /�ESil�.�i✓e.�
Owner 604" «//ws�)
By G',ea�rl,/ r'sv
CONT CTOK, AGENT
Phone — 20
i
State License '//44 i
Address GC/�F�.rlO
Address
Approved GGA
PLQM61iZd IN$p1;
of Aooliance I Units Fees
HOUSE GAS PIPING
Number of Outlets L Size of Main
Gas Piping Fees /�.i L
Tested and Approved .l�_'-l.io�....�1 ..................
DATE 4 INS ECTOA