1705LOT NO.
NO, AP 1 cFOR GAS PERMIT
�' MAf I I 1J��TCUPERTINO
DateT i "lPFWT1lN&Z Pit Nb�
_ 1 F�i� Permit o.
1� 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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
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:a Use of Premises APARTMENT
inOwrier PHILIP RAFALOW, INC. , a7 e�
Address
By F1 U[pLar 17ga r6.rr��� i Address
200 GrjStjpgCTOa, AGE
Phones -01111d I i Approved
PLUMBING INSPECT /
Phon 3? 7.5660 L
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