2800 LOT NO. // O
NO. 5�yE,
`F!P IC7z7e�l' ION FOR GAS PERMIT
D OF CUPERTINO
r a A R 2 7 1964 11
0 ¢ Date 196 Permit No. rl`+7 Qy
x o CITY OF CUPERT , ^ Fee$
App i
ication s hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i a and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
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Use of Pre 'ses o�VizGC�
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oa Owner l - AddressS� 7
z By G lddres
3 0 / CONTRACTOR, AGENT se�
— 0 Phonw29�—.3��.� /
0o State License /7r Approved
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!� PLUMBING INSPECTOR
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