561 (2) LOT NO.
N 5TILE
ET
P]� ON FOR GAS PERMIT
4MVI F CUPERTINO
Date a'1 59 S-L Permit No.
l � k� IUi! e�4r1�2��kFl�'C'Ity Fee
A I do hof Cupertino fora permit to install gas pipes,
In and/or'gai 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- P/J•• L.C,„�,CJ
i :. OwneAddress ' ./
Bylvilie, W-e .� �ti .. " Address' ad elk
,CONTRACTOR,
Phone_ IM G• . rr �= i f Approved
i I PLUMBING INSPECTOR
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