1164 (2) • Itty
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LOT NO.NO. STREET
® 1 BION FOR GAS PERMIT
DrC 81Y OF CUPERTINO
00
G/8
Date_! 19470 Permit No.-e
CITY OF CUPERTINO Fee
Application is hereby made to the City of Cupertino for a permit toinstillgas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes'
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws"applicable thereto.
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L CONTRACTOR, AGEN
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PL❑ IEING INSPECTOR
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