1689 (2) Jo � Lor No.
NO.
'M��Pt.iC �Fp R GAS PERMIT
p� �/ I UPERTINO
Date AP'4FI j CUPERT440 Permit No.
o�
® iv Fee $ 01
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
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_ 81 f /
(n ` Ownel Address
By T ; Address 4
-'1- {-V - CONTRACTOR;y EN
-',Phone �� ?—��'ti'D (; Approved=M,
y 1 LUMBING INSPECTOR '
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