2231 3 W'�i� y G•tee SLOT NO � * �.
NO. : STREET //�1 f 1 . .1 j •a��y . -q �,
1 APP.LICAATION FOR GAS ''PERMIT
CITY QFF�CUPERTINO
�^ Y Dame �-Y.v��. •�C'` `(�Y` ''"•`'195 Permit No.,_ � ,
/ • ^ . .. - . Fee
Application is.hereby made to the City of Cupertino for a permit,to install gas pipes• }:
r' and/or gas appliances at listed on the reverse side hereof•and agrees to install said pipes.
and/or.appliances in-accordance with,the'pioviisionsof.the_Plumbing Code of the City ".
i
of Cupertino, and all otherws laapplicable thereto. -
�r
Use of Premises
Z Cwner�ou,• S.t_.. Address ib l t—
BYO 14�eV— `l a tJ E s -� Address 15 J i
CON NTRACTOR, AGP.NT - 1
Phone L ' t) Approved
PL MEING INSPECTOR
i C' 0�0 o„ x w f° y,( U C P- C � .v. C 00•�':'�.n �
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