1761LOT NO. �D
NO. 8T
,?n'pp T O FOR GAS PERMIT
JUN 8 196 1 'F CUPERTINO'
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Date 1Q5_ Permit No. f�_l
I (� Io Fee $
,.•'. _ Application is hereby made to the City of Cupertino fora permit to install gaspipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes#'
,x5 and/or appliances in accordance with the provisions of the Plumbing Code of'the City
or %-upertino, and all other laws applicable thereto.
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use of Premises 45 . 1'e
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n Owner /sem_ ,_e;.,. Address Cg4 DAd - _
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