1606 (2) Y . , t) i- . . . . . . .
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� NO. 5TR9ET '
�� � � �
�FCATION FOR GAS PERMIT
�';�APR �3 i96�ITY OF CUPERTINO �
Date �.�I��.� �� /02 19fr'�-� Permit No. r �� �
C� 1 1 OF �l1FE�f�1V� Fee $ � °o
� 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 accorda�ce with the provisions of the Plumbing Code of the City
\ of Cupertino, and all other laws applicable thereto.
u
v APARTMENT '�02
. � Use of Premises
� ��a� "
i PHILIP RAFALOW, INC,
�n Owne p n Address [
I � BY • • �lum6in Jne Add[ess
fl$ IC {I&��TON� AGP.NT
Pho Campbell, Califomia Approve
0�@ -5660 ' _ ' • PLUMBING INSPECTO0. �
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