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(12ZZ,:1 V a -Q' (! �l1lK A L 2P.LOT NO.
NO. o e
®A N FOR GAS PERMIT
�►;1 1"1 4) 7 1962 I � OF CUPERTINO
Dat19-4� Z Permit No.
Ut MO Fee $
Application is hereby made to the City of Cupertino for a 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 iri accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises.
Owne� �{ Address
Byls•�I -- 1 Add res 6
CONTRACTOR, AGP.NP
Phone12— 2-3 -17%I I Approve C.
fI PLUMBING INSPECTOR
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