565 e,4 6_e LOT NO.
NO. STREET
P N FOR GAS PERMIT
�1�1ltt�djl I F CUPERTINO
Date -19�� Permit No.Fee �1n�
Geo
T�/ pFR� Nn
\ APiFalionQFherQln3if>'`tbltt Aity of Cupertino for a perm! 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: 1, .
�Of Cupertino, and all other laws applicable thereto.
R pe -0. .' Use of Premises K
v .
05 -Owner
�d e , �.0 lnr� ��., . Address
By��� { � r-(p ! •Address On W
f`_.••.� ! CONTRACTOR, RGRNT :::'.. y•
Phone 'yQ •'d7`SiD Approve
PLUMBING,INSPECTOR
X00 0
O $' ❑ o
' E C)
N ..
N
_ -w
n (S�
A - Pi( ` 'JP