1627 (2)- NO. f sTxeer
APPLICATION FOR GAS PERMIT
jIJUPERTINO
Date pp�}Permit No. C, 2
1 �D� � o
o 77
Fee $_�2
AppligTrrMs OPY0i(<(IPERTWoof.Cupertino for a permit to install gas pipes
and/or gas pllances as liste oh the reverse side hereof, and agrees to install said pipes
Vand/or appliances in accordance with the provisions of the Plumbing Code of the City "
of Cupertino, and all other laws applicable thereto.
u�
Use of Premises P RIMENT+ .
.rRM0.1P RAFALONf,_INC.
~• �iOwner • s. •^ -c - 'Address _
By•.:l✓'" "Address
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:2U0 fISt Ch OONgLµIA& AGPNT ; � �' .
Phon Phell' California' Approve
PflOne 37756601 • 1 PLUMBING INSPECTOR
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