2304 (2) `7e?'!�641 �cM^� ",/,v_ LOT NO.
NO. STREET
�� i
N APPLICA�TLION FOR GAS PERMIT
z i 1IT�Y Or CUPERTINO
0 9963
Y O
0 LL 30
o Q Date 196 3 Permit No.
3 0 sa,
Fees
' oCIATpYlicQiFn PON,)
TdIeNtonthe .�
City of Cupertino for a permit to install gas pipes
01-
an gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i m 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.
w x
r �
LL Use of Prerms s
00
oa Owner �/'+-"cam �.�' Address -�7dS S'6
zJ p
I By Address
0
3 `m Phone '� S .
wz
0 *�
oState License t/ Approved
-U p I R
g v
.9 n a y m R ❑ � ? � � b
O n n w
a y
o . z
00
z
� x
w
N
9 �
fw1 (JJ
A (l
A G,
1