579 (2) IJ
LOT NO. ^"
.NO. STReaT/
T FOR GAS PERMIT'
_) CUPERTINO
I S9
Date N J`�`�`� �{_ Permit No. 5
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�,iTY of �UPfRTg. Fee $A
App (cation is ere y ma a to toe ity 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 laws applicable thereto.
Use of Premises [ "19Grvs�- �
Owner"P<n�a 1_ e T�wv�[� L17 Address
By _� __'= Address L't4y
� CONTRACTOR. AGENT
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Phone�A'� G'' 115 0 I Approved PLUMBING INSPECT®--?
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