2517 (r;AC rr •LOT NO. �n
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"AWLICATIO,N FOR GAS PERMIT
f UG 21 1963 �A CITY OF CUPLRTINO
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3L NI T r UlYr I INH 1963 Permit No.
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O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o < and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
Use of Premises �P0(C�enLC�
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H a Owner �('maame�, st mo� Address "Ido_
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By `�-lLf'��, RY.� Address
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0 7 State License t.1616" /0I/39s Approv �
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