1714 STR
No. ® A LI NCR GAS PERMIT
f MAY 11 so o k&ERTINO
Date_ r�)F1I HTjNo Permit No: 1 71
O Lr+�� P� Fee $
12,
Application is hereby made to the City of Cupertino fora 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.
Use of Premises APARTMENT3
rvrt ' �y�
a PHILIP RAFALOW; INC.
tw C
in Owners Address
- •13y �? 3I/I'/Y'=M (ufn�in Jr Address
ZUU riStl QfbLakTOR, AGENT
PhonP61i bell, Californ' Approved
377.5660 PLUMBING INSPECTOR
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