1403 LOT NO.— �>
P4OF
N FOR GAS PERMIT
I SEP 1t CUPERTINO
t.
Datey OF CUP_FRTIN095- PermitµNo. �Zelz
Fee $
Application is hereby made to theCityof 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 ,
V of Cupertino, and all oche l'iibs applicable thereto.
Use of Premises /rF S/OKNCy
i
Owner LoiNMo,vwr _ Address o [ '
By_Ptl,? k OLIiDfAiAr.L (iii• Address
CONTRACTOR, AGP.N O Ck
AProvedZone
PLUMBING INSPBCTO
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