1753 (2) T/r < - _• LOT NO.
NO. STREET
® ipm N FOR GAS PERMIT
OF CUPERTINO
AY 17 1962
Date1�,�M /' 194 Permit No. -5-3
a . CITY OF CUPERTINO Fee $ "g
Application is hereby made to the City of Cupertino for a permit to install gal 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
I of Cupertino, and all other laws applicable thereto.
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Use of Premises 'A�"f/Otwe p'
U.) Owner Z-&2&9d% edAlIr Doe.ri:aly Address �Ail1D,9dLG
By Pii.C'DI' .�i�li/iIB�Nf -' Address
CONTRACTOR, AGENT I -
Phone Approved
PLUMBING INSPECTOR
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