432 NO. STA 118T. - �,.: �f'/L��' �J �'Y,t/✓
21 ,55 !Vt APl�LICATION FOR GAS PERMIT
CITY OF CUPERTINO
Date 5= Permit No._`Al f _
APR 291959 Fee $
ti h ebymadeRo the City of Cupertino'for;a permit to.install gas,pipes.._,
.: and/ g s'app 11c � reverse side hereof, and agrees to,install-said.pipes,,:;.;�
i'
.:and/or,appliances in accordance'witfi theprovisionsof the.Plumbing Code of the City,i
..oPCupertino, and ail other laws applicable thereto.
Use of Piemises
h Owner moi. Address
yn gyM!. L. ,HICKEYSO 5, {NC.;- Address
P. 2oDrTMci'oa?pcerir -
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Phone, Surinwain. 06111. I A PP
I,L•,. , I 1 1- Il i l PLUMBING INSPECTOR
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