1058 I1I` .k I r
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SAP LIEWdIN FOR GAS PERMIT i
1 � JKry_ CITY_tOF. CUPERTINO • a �
Date
i�J 't' Permit No `N
r< NQ a^ Fee $ �:..
A �onQlheAfiiaHATIfie City of Cupertino'for a permit to"install gas pipes
a.nd/or gas appliances'as listed on the reverse side hereof, and agrees to install said'pipes"
V, ' and/or appliances in accordance with the provisions'of the Plumbing Code of the City
of Cupertino, and all other.lawsapplicable the o:
Use of Premises
ow er 'Address
H Address
Phone PP
� A roved �
LUMRING INSPECTOR
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