442 (2) LOT NO. o [/
NO. STREET. fps .�/��
APPLICdTI N FOR GAS PERMIT
CIT 'OF CUPERTINO
Date Jl'_. 95_ Permit No.
(\ WlAa4XYhereby
Fee $
Ap09to - ty of Cupertinofor a permit to,install.gas pipes.
`and/orrgas appliances as listed onthe.reverse-side,hereof•:and agreeslto-install said pipes .
an a pliance �i a�{ it a provisions of the.Plumbing•Code of the,City
of Cup rj�Il�iYan�¢ll.ofjiale thereto.
a
u �
Use of Premises L �
.. ,Owner!x./-G o/l/ �,/-i/l •gip Address �Y/Gc s�•dILS./ -
r ei• I I ; ;
B . .. _ I- �I-Address` •- _
P. O. Box'6�6• ;''; G�
Phone I App, d i {�
PLUMBING INSPECTOR
G) z a y nen nn v � � wnC� �lGI
v ^
v
o \—
T
3 3 '
—w .