1710)T NO./ 'gZ741
ERMIT
Dater �- ? ) ER Permit
lo. /7/o
Fee $ 2 6 a
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
Owner PHILIP RAFALOW, INC. Address
By um inPr n Address
TOR, AGP.NT I
PhoneCampbell, California Approved
one - PLUMBING
mr)c)��n
OR
—
—
— —
—
—
—
—
—
—
—
--
—
— —
3