1655 CN Hf. I''e 5 1 LOT Nn.� .
NO. STREET
tG IT CNr*Ii GAS PERMIT
)?01AY1-1M- 0W
PERTINO
Date_ ANk 2 b 1969 , 1.95_ Permit No. yL_c�J
CITY OF CUPERTINO
Fee
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
V 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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Use of Premises
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�n Owner .,p Address
• CONTRACTOR, F.NT �
Phone & 7 15(o�/J Approved
PLUMBING INSPECTOR
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