2067C.e��ob LOT NO.NO _
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N FOR GAS PERMIT
LPN& s 1962 OF CUPERTINO
Dat c • � 2 193_, Permit No. &� , 7
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Fee $
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 Residence -
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Owner veep Cliffe nev Co
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S18 C'O.11'I�ONTI}�TOI�AGa
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Approved
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