827 LOT NO. A
< NO: 5 T /
PLICATIR GAS PERMIT
I?I' ' N OV 2 0 1 CUPERTINO
Date_L7 ,_,_._,/9_= 9 Permit No.
Y Ur
Fee $ S�
Application is hereby m '�!t upertino fora permit to install gas.pipes
and/or gas appliances a is erse side hereof, and agrees to install said pipes
i� and/or appliances', h the provisions of the Plumbing Code of the City
of Cupertino, and all applicable thereto.
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a Use of Premises Z— Fn /L
in , Owner// Address-L7e�
By Address z,e 1i5—
CONTRACTO , AGP.N'
Phone 15�'a - (- a!9F 3 Approved
PLUMBING INSPECTOR
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