1764NO.®s
A88AP ION FOR GAS PERMIT
jUri 8 9962 COF CUPERTINO
Date 195_ Permit No.
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C( Fee $_'�._
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.
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Use of Premises��a�
7a 7 q ec
Owners y= — - 'lt"�a— �'C. Address -,.e.,,,
BY �g Ul•—�il. Oxy Address
CON ACTOtR R, AGENT
Phone r S— >'— 5 6� o Approved
PLUMBING INSPEC
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