1613 NO. 5TREET
® A 1 FOR GAS PERMIT
P
- CUPERTINO
Date Pte, t 5_ Permit No.__z"_t_
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o CITY OF CUPERTINO" Pee $
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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.u'a Use of Premises APARTMENT
PHILIP RAFALOW, INC.
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Owner �/7J � Address4.1
By—�• & U/ Minx.Qsr- Aft_ Address
200 Cristich L("TRACTOR, AGENTPhoneboll ralifnrni2 I Approve : ZJiI566O ' II G'INSPECTOR
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