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NO. EE
® APPA ., FOR GAS PERMIT
1962 CF CUPERTINO
�PJIAY . `
Date APR 2 6 19691 5_ Permit No.
CITY CF CUPERTINdFee $ �
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Application is hereby made to the City of Cupertino fora 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 in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises
�r :P'Owner Address ♦ .
By I Address
w.r,. t....•.:
�•t - CONTRACTOR AGE"
Phone` 'i ! Approved
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