1451LOT NO.
NO. Q E
® APPLI AIN FOR GAS PERMIT
SEP 2 6 1961F CUPERTINO
Date IC�"'
Puna", _ a5- Peimit``No"'i�," ! `F.� . - '"."
Fee $ D O
Application,' is hereby made to�the CIty7'of Cupertino fo�fa`pe`Oe
r'mit.to.install'gas pipesr%�_t�
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
�v
of',Cupertlno; and all other laws applicable thereto.
Use of Premises
Y" IM Owny 1 _ Addres`55 ?Q'��� CC TC_V.q�
'w B ���G� �.jo�v> Addres� 00
CONTAACTOR��AGENT� p
hone��L /rC�?t�j, i Approve '
I
!Y