1716 IOT NO.
INo. sraeer 1 .FOR GAS PERMIT '
Y 11 1962 cF CUPERTINO JJJ
Date I ;'- 19LI/ Permit No.�`�
CITY OF C PERT& Fee.$ 12-
Application
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'l
and/or appliances in accordance with the provisions of the Plumbing Code of the,Gity
of Cupertino, and all other laws applicable thereto.
ry 'o Pr'emises" APORTMFuj e V c1.l C e 6 6
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Zo `•'.Owner•.PHII:IPA RAFALOW„ INC. Address (&Lag+-, _
BY &, ?�� h /! Address
200 Cristichce�e CTOR AG17w n�' `
PhoHau ggell, I I,: PProved
�•' PLUMBING WSPECT R
777-Tran
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OFI=ICE
COPT'
GAS SERVICE. NOTICE
BUILDING INSPECTOR'S OFFICE
`•0- CITY F•CUPERTINO
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To
You are hGa, ed-to c inec the GAS service for
Owner'or Ten
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New Service ..
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�'No. of Meters .:. .. .:..:- Reconnect
i- - Move Service ..... ..............
No. of Add
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01
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•°r "7/61-500-
PLUMBING"-IN ECTOR-
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