17097613
NO: STREET
A�!PL�tGAIONLLC�
R GAS PERMIT
Y
OUPERTINO
Date Permit No. Lr
CITY C," CUPERTINO Fee s_
Application is hereby made to the City of Cupertino for a permit to install gas pipes
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and/or gas appliances as listed on the reverse side hereof, and agrees to Install said pipes p and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
v
. � Use of Premises
APARTMENT
�a 7
Owner d P.HIILIP RAFALOW, INC Address _
By % 4 lll��'�` " ` t/ Address
CONTRACTOR, A NT
Phone
5 7_ -SI,6 T I I Approved
1 PLUMBING INSPECTO
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