1996 LOT Nd.
NO. STREETY C. - �
APPLICATI FOR GAS PERMIT
CITY OF CUPERTINO /
Date —�� 194—?-- Permit No, ��9tl
t
{� Fees '3
Application is hereby made to the City of Cupertino fora 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 lawss applicable thereto.
' Use of Premises
r7i �Owne& Address
Addres
CONTRACTOR,-AGENT
Phone 01i Approved`
p PLUMBING INSPECTOR
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