1348 (2) 0�0�lo.S PEPPfP TiPEE • LOT NO. /O
NO. STREET -
I FOR GAS PERMIT
Vo"UN 16 1961F CUPERTINO
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Date ,; 195_ Permit No-124 '
_:�k); CITY .OF. .CUPERTINO Fee
3., 'M'.rt-_"l". y xr'• ..R'!eP>n 'YG.f1 .v r'+.:
',ira ,it Apphcahon•is,hereby�madelto the.Crtygof Cuper`t wno for aipermrt}fo install gas p pes'
i N and/or gas Appliances as hsted on the.reverse side hereof, and agrees-to install said,pipes
...� " and/or appliances iri accordancewiththe provisions of`t&e_Plunibidg Code of:tWCity
of Cupertino, and all other laws applicable thereto..
UseoPPremises` -_/�E"f/DL'.r/GC'
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ti Owner Address/? 7-al
By_/U/IOY p.///ylAi vL Addre s r 1�
CONTRACTOR, AGP.NT �, .,. yJ� ? h'r�•` T 1�"L'
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