1530 (2) 2U/ 9� / L/!'LC r/rErE� L/I/YL LOT NO: /
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® I FOR GAS PERMIT !'
JAN 2 5 1 62fig CUPERTINO
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Date "1 19p� —ap
Permit No. ' C,
CITY; OF; CUPERTINO loo
Fee $— i
j .:. Application is,hereby made to the City of Cupertino for a permit tc`install gas pipes
If grid/orgas'.appliances as listed on the reverse side hereof, and agrees to install said pipes"
and%oi'appliances in accordance with the provisions of the Plumbing Code of the City
V0of CupeiFn6 and,all other laws applicable thereto.
HiffU,y�VNiLrN .84412. Address
BY Address Z.
CONTRACTOR, AGP.NT I
I �Chone':. �`"F. G1:1 Approved
�:,,, u ,_.• PLUMBING INSPECTOR 1 ,
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