444 (2) `/��5�7 Y i✓3 i.L C1C��-CJ .,.' LOT NO.
NO. STRHHT
APP IC TION JIFOR GAS PERMIT
CITY"OF CUPERTINO
Date Permit No.
Q n Fee $ 3d
I l Applica n Mfilreb�malffi the of Cupertino fora permit to install gas pipes .r ,
and/or gas appliances as listed on the reverse side hereof, and.agrees to install said pipes„
` and/or ap s cco provisions of the Plumbing Code of,the City;
of Cuperti gfTd rther—rws applil E, thereto.
8 Use of Premises
Address
1 I
gY = Address
CONTRACT GENT- //
Phone . 'P.,O. Box, �Rt6 I Approve '.c GGG�
j �j : 1 YO BJrL18,811 81 • I I PLUMBING INSPECTORXJ
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