1659 LOT NO.
NO.
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PPLIC/� 1 FOR GAS PERMIT
��}�t 11 19V CUPERTINO
l Date APR 2 6 9 T�YV� Permit No.UF
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3 MY �p
Fee $
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 APARTMENT
h Ow PHllty RAFALOW, INC/p. Address w
By
Ph C emPB ' ¢ • / [umbin Jne. Address
O B0.ACTOa, AGBNT
pbell, California Approved
gone - 660 L M81NG INSP8CT00.
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