1631A L4 k� to Un l ( c ri
,.�?.
No: sra IET.
CATION FOR GAS PERMIT
® OF CUPERTINO
Date 095_ Permit No.
' I,p�p Fee $ •�
��Y"tgFis 4/�eWQ ERTIN®e 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 APAR-rmul
a _ . T' 7- d
A'nmr
'A .
r)p
tL
'A .