455LOT NO. •'�
NO. STREET._
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
Dat Nk 195_ Permit No.
LCIMAY 7 9959 UV Fee
Application is hereby made to the City of Cupertino fora permit to install gas pipes
an df#s ffiar �,i F oe reverse side hereof, and agrees to Install said pipes,,
and`/or appliances n c th the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises
� Owner .Gi�' //Z4id Address__i[�+�G�gL%G�/1/�%
By'w ' ' • ^ •. - Address—
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Phone
P.
�. ox 578 Approved
1 loyyale;allf. �' I 1 PL UM BING INSPECTOR �+�;
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