890 (2) LOT NO.
STREET
7
APPLICATION FOR GAS PERMIT
�) /� � TY OF CUPERTINO
E C
I-9TY
Da 195_ Permit No.411 61V IOUV
Fee $ t
CIT*li( `F°n �hjrq. the City of Cupertino for a permit to install gas pipes'
and/or gas appliances a's1istcaa on thereverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City ,
?t of Cupertino, and all other laws applicable thereto.'
aUse of Premises
E
n
ti Owner_ Address
By Address
CONTRACTOR, AGRN
Phone--..- _T Approved WILLIAM D. BENEVICH
PLUMBING INSPECTOR
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