2370/ovi /Q -eozat Gam'. LOT NO._
NO. ST E7
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IAPPLICATION FOR GAS PERMIT
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i� CITY OF CUPERTINO
Date Ga' G.I0ZQ n 196 Permit No. 023 7�
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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 appliances in accordance with the provisions of the Plumbing Code. of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
Owner A61^&e
By FYGY<sFOH f�/„< 6.
CONTRACTOR, AGENT
Phone ' sy S4
State License G7�U
Address eoT��«��
Approved
PLUMBING INSPECTOR
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