1908 (2) LOT NO. �27
NO. STREET -
FOR GAS PERMIT
UPERTINO
Date J�tY,C I _ Permit No.
Fee $ 3•3—O
a CITY OF CUPERTINO
Application is hereby made to the City of Cupertino for a permit to install gas 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'llty
t! of Cupertino, and all other laws applicable thereto. [ ,
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Use of Premises
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Owner 2?,,'oilt AAddressAIL1111NI
By I i AddressCONTRACTOR, AGENTPhone .�7k- APProve
IN.4141
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