841 /. �
_LOT NO.
FG..
FOR GAS PERMIT
OV 23 1 .ITY OF CUPERTINO,
195 Permit No. O
. - Fee $ D
Application is hereby made to,the City of.Cupertino fora permit to,install gas pipes,
'and/oi 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. '
c
Use of Premises Residence
u
ti Owner BetternCunertino Homes Address 156 W. Jackson Hayward
By Edward J - Address p.0. Box 406 San Clara
CONTRACTOR; AGENT
Phone CH 3-0661 Approved ( �Z/i �Ge
PLUMBING INSPECTOR `
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