1694OT NO,
No. ACATIO F,OR GAS PERMIT
& MAY 11 1WQY UPERTINO
I Date AIRR"9 §ditI IDCDTW Permit No.
Q Fee $ .�
\\�i - Application is hereby made to the City of Cupertino for a permit to install gas pipes
(No 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.
APARTMENT
V
a Use of Premises
i 7 a'7
n1 -'Owner PH!!.!P RAFALOW. INC. I Address
Add
ress
¢uzarzn _
N ACTOR7AG . T
200 CristicliYane �; i ',� ;
Pt o team{ heH, Eai famia�. Approved
PLUMS;NGINSPEjR� ,
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