489 �4 , LOT NO.
2248 s,aeaT • A.. 1 b FOR GASP MIT
CUPERTINO'
Date J" 3Permit No.
CITY OF p�pT ^' Pees
\ Application Is here�}�'�ma4 R 11410ity of Cupertino for a permit to install gas pipes
Z, and/or gas appliances as listed on the reverse side hereof• and agrees to install said pipes.
Cand/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises ���
r7i - Owners O ��pdQ.G j Address �-� �� �•
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Hyl, ' 141G"cv c{sr.ic• IM[2.- .' Address
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C AG7 AGENT_ I '
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w � � PLUMBING INSPECTOR
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