1734a.2
LOT NO.
NO. STREET
�pL T FOR GAS PERMIT.
Fnns m®1 CI CUPERTINO
Date •CtY N A V� .- 7� Permit No. 3
CITY OF C�,I &RTINO Fee $ '
Application Is here y ma e 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'
\n and/or appliances in accordance with the provisions of the Plumbing Code of the City
ti of Cupertino, and all other laws applicable thereto. .
c
.j. ` Use of Premises IYPARTMEN 3
Ii Owner PHILIP RAFALOW INC i I Address Sa,11A&Q
I_ '
By -� ��"t��y�A�Q �/f tj3 0! -�� Address
ZOO Ciis'WLo ng TORS AGP.NT ,I I 1
Phone {.,Approved
Camp§ei, C8il19iOt8 r PLUMBING INSPECTOR i
Plyar iii -5660
5
�m
-----------