2232 .. ,io,�a � ✓`. ., ' � LOTRNO
No. STREET.
APPLICATION';F.OR t " PERMIT 9
" ii,�• i,P?. CITY:OFfl CUPERTINOII�+,;.
. Date Permit No.
I
'01" .Fee $ 5
a
• Application is hereby made to the City of Cupertino.for,a,permit to install gas pipes
r •s and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
{-sand/or appliances, iri accordance with the provisions of thet$lumbing Code of the City'
l.. .b.
�- of Cupertino, and all other laws applicable thereto.
7
Use of Premises I ►- A !tA k
Owner ITU t ASi IA Address`I LJL � \t
By wll�t3Q-�c�wJ�S _I_ LLi Address SIN
CONTRACTOR, AGENT
Phone G�— iI D l ti o-o Approved
- V PLUG ING INSPECTOR
R4
c.l :? c 2, w � - �fi' a 9 -a w 3• ^n � '� 'c7: '7y�
�rtp rt
-_ -
'O P.
T :tl
E �
v rt
g
— —w
Tr - - -----
m ^
A�