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2 1 5 5 j A PLICATION FOR GAS PERMIT
':CITY OF CUPERTINO
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Date S_ Permit-No.
APR:'2'8'10. Fee s /, 5d
\ Application is hereby made to the Citybf Cupertino for a permit.to install gas,pipes•,,.,r
and/ 1 3�p ce ¢s� gtj�¢�reverse side'hereof, and agrees•to,install said pipes._,
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-- and/or appliances;m a c r anc the provisions of the Plumbing Code of the.•City-,i J
of Cupertino, Ad•all other laws applicable thereto.
Use of Premises d //% r • .
/ �Owner//%/ G'1`7i ij2�Address -A
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By W. L. HICKFvS �—Address . .
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CONTRACTOR'.ncexr.;.
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