937 j
LOT NO:
t ..•�.! NO. - STREET
��✓ ' :• .s.: •,APP CATION FOR ,GAS PERMIT
II 7`� ; 1 �• GITY OF CUPERTINO
Date L'.7: ? _.;�}�:: :'::':�,rr,:Y;,d' -
��r`"r•t�tU 195:_ Permit No. '
VU["ERTINO
�9 Fee $
Q - _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 - _ Address _
' By_�I'l/c'��'lL!/77�• Address
`
- �,/ CONTRACTOR, AGP.NT
Phone [�j .3 — G3 Approved � cher!/ J
PLUMBING INSPECTOR
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