1347 (2) PEPPE,P - ne-15.1F LOT NO.
NO. STREETAD _
GSN FOR GAS PERMIT
• OF CUPERTINO •- -
R0�UN 16 1
•„• _ Date : ' «•. 195_, PermkNo:�r,+t ." '49
-:CITY 'OF':CUPERTINO Fee $ A
t, N Application is hereby made to the City of Cupertino for peermmit to install gas pipes''
•� .;
and/or gas appliances as listed on the reyefse�ssidre h eof a-rfd agrees to install said pipe.
b ..'and/or apphances;'in accordance�wrth the;provisions•of the°Plumbmgn(Eae,of the-6ity>',I',
-.f r
.of Cupertino and all-other laws apphcable;thereto4. z. r •• -,.
Use oFPremises- "`-��,f/DeA/
u_ rf~r'"`.."r,._.,,R„':;;::.it�' w:,=•�:Y�`� `s-'el•:Sy: r
Owne-e"Im, eila A/ r,v A.CDRS . Address
By PirAPY ,0, ddress p
.- CONTRACTOR, AGENT �� �� <
i` one CW-6 k/// I. ' Approved
I - Q PLUMBING INSPECTO
CL
Wd G OC :in w_i Wry
" +,
-----------------
d
ry G I aR 4
w Q �
3
v m r b
O i O N ry