1762Q�YJC�C(L �+a-aGXK ��aV `LOT NO.
NO. STREET '
AT -ION FOR GAS PERMIT
fpOF C'UPERTINO
JIM 8 3ss2f V
Date 195_ Permit No. 1 l bZ
CITY C3= CUPERTIN10 Fee's
Application is hereby made to the Ci of Cupertino for permit to install 'gas i es
PP Y City P P 8 P P
"r; and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
,i 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 •4
444),,z 74- --4
717pp � /_-
ti Owne .i y' :• � )W-:. Address A-¢
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