2020LOT NO. -x4L J
® �AipllATION FOR GAS PERMIT
TY
SEP 2 D 1962 OF CUPERTINO
DateS./T }D 19561-- Permit No.
N CITY. OF, CUKHTMU Fee $ j ya
N Application is hereby made to the City of Cupertino fora 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. I
Use of Premises
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Owner �i�'Jtn U��i Address
By ZGw So a_ rf i '-� Address
CONTRACTOR, AGP.NT
Phone i Approved
PLUMBING INSPECTOR
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