2423 IAT NO.
NO. -". STREET
// �„
N --APPLICATION FOR GAS PERMIT
Z CITY OF CUPERTINO
xo JUL 19
3 U Date �� , 196-3 Permit No. •�
w Y 0F C' . :RPee$_ 2
O "'A'pphcation is 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.
Use of Premises '4z 6,
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as Ownero/?l d j Address
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20 y CO TRACTOR, AGENT Address��' .�p1.' S��
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aState Licensee' 6 3 Approved ` .e4w!iL O
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