1571 ')-.00q0 fAc�-1 1 C eE LANG LOT NO. 1
NO. STeeET
VOL N FOR GAS PERMIT
OF CUPERTINO"
AR 1 62
Date — 190 Permit No. - I
CITY OF, CUPERTINO Fee $_01
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
N and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
u
c
/ /-/!•�
a Use of Premises—
Own er /tl" 7 /lO� I t Address
/L — �o.J t=S Address/ tool 1
CO17ACTOa� AGENT
Phone C L BOO I I Approve
I PLUMBING INSPECT
n C) C
---------------------
� E �
3
m ('1
y `S
A