1668 QO LOT NO. J= '
NO. STRa
A P ICAT O' GAS PERMIT
ff4AY 11CO20F ERTINO
Date ( }QO Permit No.���
uu ��(( Fee $ '2—
Application is hereby made to the City of Cupertino fora permit to install gas pipes
'O and/or gas appliances.as listed on the reverse side hereofrand agrees,to install said pipes;:
and/or appliances in accordance with the provisions of the Plumbing Code of the City. ,
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of Cupertino, and all other laws applicable thereto.P PP
Use ofPremis'eS1 APARTMFNT 1
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A5 Owner PHILIP RAFAI nAddress 9 ..� t dru ;i
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By �• 7111
aann.� ,,- Address
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200 Crl$fiffICTOR, AGE r
Phon I Approved
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