1713 1. 442 2 i ( , �! /l
LOT NO.
No.
Em • 'i.FOR GAS PERMIT
AY 11 196FY
C 1CUPERTINO
Date � RTINO- Permit No. - ( , o?
L;I ITN �
Fee S .2- —
\`�' 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.
v'•
z.. 'IJse of Premises AFAR MENT - ,Z
W11P RAFALOW, INC. � a�
.Owner ' Address
.1 j Address
200 CriSti6lF2MT@ACTOR, AGM' .I 6 Approved
Phon
6em. Plt-California ! PP
I PLUMBING INSPEC
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