2372 '�y- L G - e= / LOT NO. A
NO. /`STREET
N / ,APPLICATION FOR GAS PERMIT
;w i GITY� OC CUFGRTINO
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' JUN 21 13
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3 a Date — ` —= 2.y --- 19G�3 , Permit No.
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O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
iN and/or appliances In accordance with the provisions of the Plumbing Code of the City
a of Cupertino, and all other laws applicable thereto.
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Use of Premises �/ut5'Lwx
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State License SCC Approved
U 1` PLUMBING INSPECTOR
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