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� rvo. s�xeer ` . „
D �� : FOR GAS PERMIT
C F CUPERTINO
' ! APR. 3 962 ��./ / �7
Date � /� , 19X7�. Permit No. �b L ( ,
� CIT OF CUPERTIN� Fee $ � �F
� C � 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.
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� Use of Premises�pQ�T.�E � •3
� � a`I
�n Owng�,��HILIP RAFALOW, INC. Address �
B •� um�in � �nc Address �
Y--ppe � �n I
TPtACTOR� AGENT. . �
Pho pC�ampbell, California t Approved �
YIIOpB - ' � ` PLIJMBING INSPECTO
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