1991 (2) /rte I G/� • LOT NO.
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APPLICATION ypI'O' N FOR GAS PERMIT
It AUG Q(3 0 9962 Clfc;IOF CUPERTINO
N
DatIM . , l 4'g Permit No. / V
5
Fee Ste. C3
Application is hereby made to the City of Cupertino.for a permit to install gas pipes
.i and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
o� 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
nOwner Addresser 1�
By 'i Address Y C s gym+ d
CONTRACTOR, AGENT '/
Phone&:?—.2 72 I _ i Approved l
PLUMBING INSPECTOR
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