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MA'�k?ILLIjg*TI .:FOR GAS
CITY OF CUPERTINO
PERMIT
I. Date @PTY2 Q:r 16WPERTIMP Permit No. - 1701.
1�1 0.0 •..
QFee $ L-12-
Application
2Application 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. 1
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aUse of Premises
�n .Owner2x&� .o/ ',"�. Address k'fC' �22F,fdi �u�'c
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