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,APPLICATION FOR GAS PERMIT
CI OF CUPERTINO
Dateq1� Permit No.—_Q
Fee $ S'n
AP ibatiorb,1&ere�iyj,�ii d��l rty of Cupertino for,a permit to install gas pipes
and/or gas appliances as listed on the 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 1 — F /✓
Address
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PLUMBING INSPECTOR
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,APPLICATION FOR GAS PERMIT
CI OF CUPERTINO
Dateq1� Permit No.—_Q
Fee $ S'n
AP ibatiorb,1&ere�iyj,�ii d��l rty of Cupertino for,a permit to install gas pipes
and/or gas appliances as listed on the 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 1 — F /✓
Address
ApprovedWILL1AM D RFNEVIru-
PLUMBING INSPECTOR
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