1674bIQL / NO - r_
VAPPLICA I ,FOR GAS PERMIT
OINt 11 196 . CUPERTINO
DateAPR 2 6 19 Permit No. A(
--ell 1. v; -TINY,
Fee $
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'
' `4yand/or appliances in accordance with the provisions of the Plumbing Code of tlie'City
. 'L
hof Cupertino, and all other laws applicable thereto. .
R ,
Use of Premises �>
.+' 0 •Owner al+o i` ' Address _
1' By
-1��'/J / Address Y
1 CONTRACTOR, AGENT
Phone Ga 7' 1 G:60 I t APProved
UMBING INSPECTOR .
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