2384LOT NO. I/ I --
U,,/
iia,,/ JUL 2 APftICATION FOR GAS PERMIT
CITY OF CUPERTIN0
oat',,ITY P`ERTy� t Permit No.f_
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
in Owner�r,K�ro n r ti K^-'�--n.,� Address _
By Lir z ��%_ �� Address33
CONTRACTOR, A4.NT
Phone—Ax L, — 444 3 I Approved
PLUMBING INSPECTOR
a
T