1664l l(,� 6 �-b LOT No.�t
NO. STREET
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AM, CAT Q FOR GAS PERMIT
�+�tt II, UPERTINO
Date I 1962, 1 E Permit No.
CITY Orr
Cop Epr Fee $-,a �
Application is hereby made-fo thj�Igof 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.
Use of
ownerc7MUP RAFALOW, INC
`j'• (� lum�inyr -
By
hN'rNKCTOR, AGENT
PhoneCa��ell, California i
7 a 7 �•�-
Address
Address
Approved
LUMaING INSPECTOR
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