1724 (2) LOT NO. /
VtItI1 OR GAS. PERMIT
AY 11 ..19b�11%CUPERTINO
Date .00L 17
1 Z Permi Z T
9 _ t No.
CITY E CUPERTINO, 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 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 APARTMFAIT ,3
12n!?.,Owner PCF+IFM 0AFALOW INC 1 i Address
By t. !7 w`../ Pitne�in �nl I Address_
200 CristlobokniCTOE; AGENT
Phon�aTPbell, Califor �t= I ' Approved
i-Bo e377-5660 PLUMBING INSPECTOR
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