1611 (2) 6 I 2C,- Ao l 'Y 1 Cy V dCCG
NO. STABET t -
1 bN FOR GAS PERMIT
® CUPERTINODate AP 2 _ Permit No. 1
1 v n[ "�� R Nl^, _ O�
gl t b OF g1Ne�tb��l''C Fee $_
� Ap S tin 1 ere t Ity 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.
v
a Use of Premises ADARTMENT
3n Owner PHILIP RAFALOW, INC. 7a��✓ Q �4�
Address
By 9_V141 IM I. Q f_ Address \
C TRACTOR, rP.NT
PL2200 Cristich Lane I Approved
learn i "PLUMBING INSPECT
, -- 177ARFn -
O
�o T
m C1 i Kf
v E �
—w