1649 LOT NO.
NO. IffRAT
P °I ATION';FOR GAS PERMIT
.q O
II APR 2 6"� 6L �. CITWOF� CUPERTINO
` 'iDate 7 a ,t 19��Z Permit No.L-
CITY`OF. UPERTINO
Fee $ O t�
Application•is he eby 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
and/or appliances in accordance with the provisions of the Plumbing Code of the Cit'y'l;
of Cupertino, and all er laws applicable thereto.
Use of Premise
41
Ow _ Address � e .
BI�S7"G/1 OaIP Address 1. /y6 'r"t
l" AKfR�LI�R'TGP.NT
Phone 9 . Approved
'j PLUMBING INSPECTOR
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