2298 LOT NO. /"✓tJ.I
NO��I /i..:ST`,REE:I ' �` � [1, .•,
APPLICATION'.FOR GAS PERMIT
z i I C,6'CITY,.OP CUPERTINO
� MAY 2., 1 u�
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3 < Date n -•rr e4o,. nT•19b Permit No.
U llJ11 UI U'+il LI\f
= LL Pee $ /"15�
0 ' Application is hereby made to the City of Cupertino for a permit to install'gas pipes .
o a and/or gas appliances as listed on the reverse side hereof, and agrees to iiistall said pipes ,.
im and/or appliances in accordance with the provisions of the Plumbing Code'of the City'
v, '
w of Cupertino, and all oth laws applicable thereto. .•
Use of Premises
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Address Address
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TCTOR, AGENTc`C V '
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WILLIAM
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m a WILLIAM D• BENEVICK
0 , tate License Approved
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PLUMBING INSPECTOR -
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