1679i6
MAY �►PPC,A �N FOR GAS PERMIT
/+ I q /11 �"�u�tLCI OFCUPERTINO �/ '7
Date CIT`PP Ii�'��'>:7�1P&M. JD5- Permit No. 6 7
Fee $ -�
r+ " Application is hereby made to the City of Cupertino for,a permit to install gas pipes
'a'
/or gas appliances as listed on the reverse side hereof, and agrees to install said pipesz
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 APARTMEN _" `"" . .
in - iOwneil A LIP RAFALOW, INC. Address
Addres
200 Cdstic4rtWWrod;'AcE" .:
PhonLCamohetl (.a0forni8 ' �.`i..Approved
�Phone 377. LUMBING'INM1PECTOa
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AN
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