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445 (2) /D• tG/ /LYG.1�GtC.t/"'`� LOT NO. NO. _ STREET: ,.APPLICATION FOR GAS PERMIT 'CITY OF CUPERTINO Date 491 Permit No. IMI 104 ' App t!on e by o t y of Cupertino for a permit to install.gas pipes and/or gas appliances-as:listed on the reverse sidehereof-and agrees to install said pipes.-•. • ;" an or' Imo' >a provisions of the Plumbing Code.of the City ' 'of Cuper'fih1o,,and�all of e., a )RL3i51e thereto. '�• ❑ f Use of Premises Owner /�/+/S/ . 40i Address 14 -l/L1�/ - i . „B . -'Address_ t:. CONTRACTOR/AGENT P. O. tlaz 5 tl A roved Phone PP, r , I_,_1,a_ Urlf1 0O.rN� 1 J 1 ' t 7 PLUMBING INSPECTOR t�pl•,`i! w U � w 0 ° 9 :4 rt � L1 'fl R w a �o -- --- ——— — ------ - O