452 (2) A�s
LOT NO.
NO. - TRHHi.y
.:.}
PPLKAT1Ok FOR GAS PERMIT
,a
CITY OF CUPERTINO'
Date �— , '195_ Permit No.
:49,n
� Fee S
• �onits ha he City of Cupertino for a'.permit to install gas pipes' a..
and or'gas appliances.as;listed:on the reverse`side,,hereof, and,agrees to instalL,said pipes..
(( .",and/or a pliances 1n,�{�jW th.the.provisions oEthe Plumbing Code of the City
'j1• ' einc�nd�!(�flCedA�d licablethereto: .
Use of Premises /Ffz6t 'r
fn Owner j/ Address
, .
By.W. L; HICK ' c�nwie '•"t•- !n-:Address e/
�.. •' P. C0147E CTozj yHNT
i I Approvedi r r�
'Phone 8pnn�... 1 -1 r
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