577 LOT NO. i4
NO. STREET -
P ION FOR GAS PERMIT
C F CUPERTINO
Date S q Permit No. ;f�W
Fee V�/ n(�[[ CCDD II�N((�� 5j
\ t�p0tiohlfs h il4 RT1 thYCity 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 1°C.P/J• L/! � .
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J Owner_'1�P.n� Q,��vto� ' Address
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ACTOR,
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` CONTRACTOR, AGENT -i'�' 1
Phone (M_ PPro a 1 PLOMEING INSPECTOR
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