1464 (2) / 1 , EAG( ��'< �� 4AA1C
4Z9 LOT NO. r^�+
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NO. STREET t `
~ ® ATION FOR GAS PERMIT
etc y� CITY OF CUPERTINO
Date - 'S 1�"�^��1/ ,•195_ . Permit No.-- � �..f
CITY-.OF�f,� t� -- •- - •ry
__ Fee'$- : 06
4Applicatlo6Is�hi ieby made-tb the City�of Cupertino for.a.peimrt to iristalh s,pipes,...,
and/or gas apphances'as Lsted]ontther a 'her ofeand�agrees;to'�ins�tal{aP'!, iQ-I.M •
he rej,t„Sitio Kcrer^�';Fi},..,gr v:L"�:., and , pip
and/or appliances in accordance with ihe�proviSin- el"',
mbmg:CoderoPthe;Clty,,;'
of Cupertino, and all other laws applicable thereto.
Use of Premises—
Owner?/
remises
- y.^�-+ted
Owner �.�.��C�/ /7b�� Addres'7
1 � _
gyA)/L%)EaZ — :. ONtS Address 7a y
1 CONTRACTOR AGENT
/ Phone �� 460 1 I Approve '
� .� jl PLUMBING INSPEC R
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