1683 (2) / 7 ;
/ D OT NO.
NO. s ffiT
APPLICA it GAS PERMIT
MAY 11 IyJ�Yr CUPERTINO
s
6 let
Date NO-.O- Permit No.
'J. -11
Fee $A i
\p Application is hereby:made to the 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
c and/or appliances in accordance with the provisions of the Plumbing Code of the�Eity
of Cupertino, and all other laws applicable thereto.
P PP i . r
' Use of Premises �1�nmi./ J y ' _'•/^�
r7ih`- �Owner J��-�i� //77�/�•� o..EZ,�� •� t, Address / �o2t.lio�'iu �caa�f"r'
typ Bly /wl .fix r� tp;Address�a
CONTRACTOR GPNT
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PLUMBING INSPECTOR "
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