1732NO. STREE'I
qAlgik&�C MN �QR GAS PERMIT
,,MAY 11 YE Or ERTINO
Date—)14 , 19 Permit No.A //3v-1
o CI C' CEJ WINO Fees �
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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises APARTAAFNT 1� /
`. 0)Owner WILIP RAFALOW, INC. I Address
'r..:
BY `- f71 1Cp/Aq�Rl90 L• Q Address
200 Crl$IICI LEIIC CTOR, AG. T.
�' PhoRSamy�ell 6alifernia Approved
PLUMBING INSPECTOR
w, ° . P" is 3177-5660
I L 11
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