1814 (2) •.' c� c�1 LOT NO. �_
NO. STREET
®_ PLi1Q„rjT FOR GAPERMIT IT
CUPERTINO
Date IJUNQ ph3' Permit No.
Fee $
ApPlcon 3here^P tOPi y of Cupertino fora
�
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.
c
Use of Premises / E t--4 /,
GO Owner � �, _ AddreSS� f ��
i _
By-W& 1 — O U Address
} CONTRACTOR, AGP.NT I
Phone L I O O O Approved
PLUMEI INSPEC OR
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