966 (2) / L/ Yy lNIJ..C� ., LOT NO.
NO. Q S5T 1
A QATION FOR GAS PERMIT
MAY 16 960 CITY OF CUPERTINO
D 47, 19J 4 Permit No.
OF CUPS WINO e$
Fee $ z'��
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 City
of Cupertino, and all other laws applicable thereto.
Use of Premises
i
h Owne — Address
By Joe Amaral' Plumbing, Ing: Aadress33 N
I�.�O ACTORS AGENT
Phone— Q 3 I Approved
t I I PLUMBING INSPECTOR t
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