580 LOT NO. �� •---
NO. STREET
fir.& PL�C,,,�1"'ON
FOR GAS PERMIT ,
I F CUPERTINO: {'—��
Date �l q Permit No. d_�.._
nC yD RINiFee $_i--
1,., ApBliaony6ihereb rty of Cupertino fora permit to install gas pipes
1 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 PremisesrQP�o
n Owner_"„ e'le s1�.CP_I �irot Address /
i
' BY {�����_ � '- i-Address aIe2oe`1( .•t
eON•TIRAC5TO0R�. AGPNT i
Approve(
-Z of
PLUMBING INSPECTOR
Er
FT
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