1708j o I g k yl V A 1C3F7i 0--.1 11.1f
NO. STREET
46APPPP.LC�-5,4TiiON FOR GAS PERMIT
® d OF CUPERTINO
i r:�Y 11 1962 /^
Date 19LI Permit No.
�R>
CITY OF CUPERTINO Fee S
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 Premises
APARTMENT
Ii Owner PHILIP RAFALOW, INC �� ����
n Address
ByoP ur.s�In r .Jr I Address
"WW(ACTOR, AGENT , I
Phone bell, California 1 Approved
e I I PLUMBING INSPECT
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