566 (2) LOT NO.
13
NO. MEET
PLT N FORGAS PERMIT
I F CUPERTINODate1'raf1959 C- Permit'No. ��"' o
S�
ICY QF WPIaRTINQ Fee $
A i a ion Is here y ma e.to t e City of Cupertino for a 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
u .
75 : :OwnerL�yiv,J[.�e �'n -' Co Address
By Li ' IC1 e"Ay,:� to, Address c Cl
' ',+: ' I ICONTRACT R, AGENT
:Phone � 1:11,;n :` �+ F Approved' <
(( PLUMBING INSPECTOR lY `
2o2a44o = 6y/&.
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