1680I O \ A < LOT NO. A� G
NO 1 f%
�,�M�1f 1P �TI FOR GAS PERMIT
1 I P CUPERTINO
Date Tom' %?t?1IPFRT,IIPF73t_ Permit No.— /J:�
'T., 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.
Use of
PHILIP RAFALOw, INC.
T
`Address
Appiove
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