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APPGCATION FOR GAS PERMIT
Z `— CITY•OP CUPERTINO
xo ` 'MAY 2`� 153 e
3 a Date _'S% ,�O 196 Permit No. �J7 ••
LL U f Y OF URLH 1 ; `111 Pee'$
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o W and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'z U7 and/or appliances in accordance with the provisions of the Plumbing Code of t'lie City•
a w ofCupertino, and all othe aws applicable thereto. t�
J LL Use of Premises —4V
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3 Owner Address
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3 F C A OR, GENT
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w Z La - , IwX3 6ps -` 1 WJI LIAM D. BENEVICH
ate License Approve
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PLUMBING INSPECTOR'
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