459 �D�IoD l LOT NO.
NO. STREET 2
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
Date —X;J�E_.� 5 Permit No.
7 �O
•W r Fee $
Applic ion is hereby made to the W Cupertino for a permit to install gas pipes
I_ and/or gas ilfice'litw the reverse side hereof, and agrees to install said pipes
\�\ and/or appliances in actor77y1�fovisions 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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Bye, _• , • Address
ONTRAZT R i� ,/
Phone P. 6. 8ox D6 Approved/ z,
OUnnyva 0. U8111T. PLUMBING INSPECTOR �.^�
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