1700 (2)O - LOT NO.
�MAYP YIC ;FOR GAS PERMIT
1 11 }¢y CU"RTINO
Date .ARR/2 ir��iI1PFRjQ Permit No.
Fee $�
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 Premisescl'a�7
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