1686 /O/60 W LOT NO
No. ® 'rte Iq *OR GAS PERMIT
f.�,l M AY 1 19r(�ITlJ CUPERTINO
Date APR 2 6 t962 �L r119�55 Permit No. �."5' 161 , IIYO Fee IS
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
Llo and/or appliances in accordance with the provisions of the Plumbing Code of the City
I of.'Cupertino, and all other laws applicable thereto.
v �''
" - Use of PremisesS t.to-dn
Owner j Ii Address
:gr•w.lB. .I. _ _
Address
CONTRACTOR] AGRNT •G
t• Phone
�•j(y_i. ' • a4 - LUMEING INSPECTOR
ro o. �
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