1346 (2) d.O d 95 PEPPE/� . '7�PE� LOT NO.
STREET
APPLICATION FOR GAS PERMIT
® CITY. OF CUPERTINO-
°. tdD ;-195_,=A: ,, Permit No. _ �V
Fee $_
((�� p�pT 1
CITY 4�ic�tWHRT4Mde to the City of Cupertino for a permit to install gas pipes F
\ and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes . r
1 A and/or appliances in'accordance with the provisions of the Plumbing Code of the City 4
�l of Cupertino, and all other laws applicable thereto.
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Use of Premises iPrs<IAO-Alcz-
a, -
�n %Owner Camoia&mlti AtrN BAV.49 Address .v T r
By "WV Y �TR.C/i/HA�N< i i Address _
CONACTOR, AGENT
r��rone
FiP—(r—�c/// ! Approve
!� .. PLUM DING INSPEC OR
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