1682 (2) 7L
O V ✓" LOT NO. c--
NO. S
APPLICAT O it GAS PERMIT
MAY L UPERTINO
DatePermit No.
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Fee $ r .
Application is hereby made to the'Cityof Cupertino for a permit to install ea2pipes
\,b and/or gas appliances as listed on the reverse side hereof, and agrees to install-said pipes
UK " and/or-appliances in accordance with the ptdvisions of the Plumbing Code,of t}ie" ty;j,
of Cupertino, and all other laws applicable thereto.24
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Use of Premises
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En! '-.Oewner ;.AddressV.
I r,tBy 1,Address�o
Yk �' CONTRACTOR, (GP,NT Approved �,Y-� 1
PLUMBING INSPECTOR!,
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