581 (2) J Nil x.—••<r
•Q/D �� LOT NO. V
NO. STREET. '
LaC,
OR GAS PERMIT
UPERTINO'
.I�f Date
Permit No.
CITY OF CUPERTINO Fee $
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
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of Cupertino, and all other laws applicable thereto.
v
Use of Premises�L'�, C� � Cita /1C'Gtr.ccs.C./
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Owner J—LrL1 j- I —A On Address
BYIN ) ll Ctrl'-�.�Ja�- ' -I-Address �ie2Q c7 U�y
CONTRACTOR, AGENT 1
Phone In • h O I I Approved ✓
i ni i 1 f i t I i t i PLUMBING INSPECTOR �'r-'1
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