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1405 (2) Cy t) LOT NO. / NO., STREET ICATION FOR GAS PERMIT ® iTY OF CUPERTINO 195_ Permit.No. / 61 c, � - ; vD 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 G1 Z c.'.til 3 rt •° > �i o^ � �' 3 _2 ° 3 ?1 n 'ti '.b w N N a y c— z c ————————————— —w ro m m y ,