1490LOT NO.._._
N 8
�NOV 1,Alj4PbLIC�TION FOR GAS PERMIT
1 �[�TY OF CUPERTINO
'Date" Y& '1..�1pATlnln, 195_ Permit No. / -.4r O
Fee $�
Application is hereby made to the City 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
r?LCY NtiAddres,4-" o (:fA' t.`)Qtr
�CQ— �O tiles. Address G` 02 Y-
CON7RACTOR, AGENT l.,
� -00 Approve
PLUMBING INSPECT R
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