1482/v
LOT NO.
kS PERMIT
NO
195_ Permit No.
Fee $ ` O
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/or 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.
Use of Premises_// 7n
Ow//n��er�� {� Y L C _ _ Addrel(j Ts J
ByN10) �' J�N� Address 0 aQ
ONTR/�CTOR, P,NT
Phone' / CIT06 ` -00 Approve
PLUMBING INSPECTOR
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