888�_ C!J �✓ /� .I//'� LOT No.
{-NO. STREET a•�
1
APPLICATION FOR GAS PERMIT
fI F CTjrERTINO'
Dat. 'zPermit No.
Fee$ •S�
Ap n a 11ereb " e e ty of Cupertino.for a permit to install gas pipes
and/or gas appliances as hste on h rever lovi i hereof, and agrees to install said pipes
and/or appliances in.accordance with the p1ovisions of the Plumbing Code of. the City'
of Cupertino, and all other laws applicable thereto.
Use of Premises_/
Owner'X/(
n n .
CONTRACTOR, A ,NT• y .�� WILLIAM D. BENEVICH
Approved
PLUMBING INSPECTOR .
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