2233 AW
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1; ,{• ' APPLICATION 400 GAS PERMIT
V,
CITY.OF.CUPERTINO'
G3�•pr .�i'Date 195_, Permit No. �2..Q.33
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Fee $ � ' O
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ana �srfiereby'madettoythe City of Cupertino for.a permit to install gas pipes
rW;gas appbance5a,fisted 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
3 of{Cyp'ertino, and all,other laws applicable thereto.
Use of Premises
21 7
W Owner /ELISA Address ��JL•L�4� L� - x:
ByAddres
CONTRACTOR, AGENT
Phone G L I C>k-fe O 4z�, Approved
PLUMEING INSPECT00.
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