563 C'`f wJ LOT NO. t
• NO. 3'IRHHT /
PPRI N FOR GAS PERMIT
e'"C�Ilnm�CI F CUPERTINO /
DateI`� S� Permit No.
PTY P� PPPE�T1N� Fee a
' ' '• A I c do i her y ma e o he,City of Cupertino for a�permit to install gas pipes,
Iv,•) . 'and/or gas appliances as listed on thereverseside hereof,-and agrees to install said pipes
and/or appliances in accordance withthe-provisions of the Plumbing Code of,the;City :
of Cupertino, and all other laws applicable thereto.
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Use of PremisesP�
r7 Owner F t�MA j a( nne e- �.a r�of � Address
BY I Address 6jet �d,00Ct�
_ CONTHACTOa��AGENT '• - '
Approve(
Phone Vvt'lo: 5O i . pp
i:r• PLUMBING INSPECTOR
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