1806 LOT NO.
NO. ET
A�PPL�IC�fTFOR GAS PERMIT
JU
N 15 196119 CUPERTINO
Date 1 Permit No. '�i/��yy�i0
CITY OF. CUPER�lNO- Fee $ �
Application is hereby made to the City of Cupertino fora 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.
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Use of Premises
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�n Owner l/ Address eZA�ee,-
$y/«� �`� ' Address 90 ��r
CON ACTOR, AGENT
Phonc,AX-6-.1963 Approved
PLUMBING INSPECTOR
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