445 /D• tG/ /LYG.1�GtC.t/"'`� LOT NO.
NO. _ STREET:
,.APPLICATION FOR GAS PERMIT
'CITY OF CUPERTINO
Date 491 Permit No.
IMI 104
' App t!on e by o t y of Cupertino for a permit to install.gas pipes
and/or gas appliances-as:listed on the reverse sidehereof-and agrees to install said pipes.-•. •
;" an or' Imo' >a provisions of the Plumbing Code.of the City
' 'of Cuper'fih1o,,and�all of e., a )RL3i51e thereto. '�•
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Use of Premises
Owner /�/+/S/ . 40i Address 14 -l/L1�/ -
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„B . -'Address_
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CONTRACTOR/AGENT
P. O. tlaz 5 tl A roved
Phone PP, r ,
I_,_1,a_ Urlf1 0O.rN� 1 J 1 ' t 7 PLUMBING INSPECTOR t�pl•,`i!
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