1405 (2) Cy t) LOT NO. /
NO., STREET
ICATION FOR GAS PERMIT
® iTY OF CUPERTINO
195_ Permit.No. / 61 c,
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Fee $
CITY ff Ct ,, 4 T- _
Ap icati to the City of Cuperbn fo atpermrt to install'gas pipes
s'Fand/or gas appliances aS hsted;on.the'reverse side.hereof„and9agrees-to'iristall Bald plpesz`�
;and/or app lrances;in`accorda`nce,-wlth the,ptovlswns oE[he Plumbing)-�C de oF'the City
,I —V—of Cu peitino,and:alLother laas.apphcableahereto � SFV- � ) ` `-
d"'v,y'n ;ryOwner CO/N/f�v�✓wre[7"ii ALO Rs Address .t -r C
By Y //amn o Address
'y CONTRACTOR, AGENT
Lam' (4one Approved PLUMBING` r 1v�5
1, _`�� _ _ -�'+--•� INSPECTOR
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