1712 ;Z A
NO. .. STREET - •• '
�1 4N[� FOR GAS PERMIT
9� �F CUPERTINO
MAY 11962 i
Date •L ,. 19 z' Permit No.
d'c' .
'CITY <Q :`CUPERTINO iFee $
Application_,is hereby made to the City of Cupertino fora pemit to installrgas pipe`s.
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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UseofPremises APARTMFNT
J1 ' ` -PHILIP �a7
IY _: a+iq..Owner RAFALOW, IN Address
# By r Addresni
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Iti"�r- � ACTORS AG.NT '�`
r, Phomy�e��:,6alife�nia�_ 6 .
Approve
PL MBING INSP O
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