1689 Jo � Lor No.
NO.
'M��Pt.iC �Fp R GAS PERMIT
p� �/ I UPERTINO
Date AP'4FI j CUPERT440 Permit No.
o�
® iv Fee $ 01
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_ 81 f /
(n ` Ownel Address
By T ; Address 4
-'1- {-V - CONTRACTOR;y EN
-',Phone �� ?—��'ti'D (; Approved=M,
y 1 LUMBING INSPECTOR '
gC) Z 5. � 0 �IL� n �< G� tSC1C� Ew
� _. D• o w .w. w
v `� ,G� to Y '� m n•- � N ^ N w..
- --------------------
ti m ( \
loo lob .
� z
------------ -----w .
n
e v