1473 (2) —/ G l�EF1QT�E� LA Aj LOT NO. '
NO. STREET _
® �A aI A N FOR. GAS PERMIT
`� OF CUPERTINO
OCT 3 1961
Date : OCT 2 19C1 195_ Permlt 'No. /5 73
!� CITY OF CUPERTINO Fee .$
App7iwcahois�herebyimadeato.the�Clty-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.
u
Use of Premises
Owner�Z pL k� 7 / 7 owes ' Address430
(In gy �/L Address TOQ �Q t �•
�]Tc/, CONTRACTORS AGP.NT �, � �'.
Phone C L O �F@ O Approv (�
PLUMBING INSPECTOR ,
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