1491/b ReE., LAQE
ET
�NOV 1� jq&'pP I _ATION FOR GAS
CITY OF CUPERTINO
CITY OROCRUREW)PNOate , 195_
LOT NO. S 11
PERMIT
Permit No.
Fee $� ' fl
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
/C t rL-1
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