895/
N
LOT NO. -,07 2_
TION FOR GAS PERMIT
OF CUPERTINO
Permit No. - CS
Wxltcal�p'Ir is hW91 �h�1 j�ie City of Cupertino for a permit to install gas pipes
and/or gas appliances as 'fp (kje reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises /
Owner Address
By rAddress
CONTRACTOR, AG.NT
,Phone I Approved WILLIAM D. BENEVICIi
°�t PLUMBING INSPECTOR 6