1617 (2) NO. STREET
APPL ATI ' M FOR GAS PERMIT
DrK yOF CUPERTINO
A 191962 rtle Dat195- Permit No.
O ('[ Fee $ +�
Cffhfica fn isoUpQ e City of Cupertino fora permit to install gas pipes
and/or gas appliances as este on a 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.
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Use of Premises APARTMENT . 3
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Ownecr7<PHILIP RAFALOW, INC. I Address_
By �? 1 Address
_ 200 CristIC6Q�K�ACTOR, AG. r i
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ti Phot iunat:ll California ; Approv
Phone 377.5660_ PLUMBING INSPP.CTOR
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