893 (2) NO. STREET -
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(CATION FOR GAS PERMIT
�•6� �1 CITY OF CUPERTINO
+JAN 20 1960 � -
Date 195_ Permit No.
(CITY Ct , CURERTINO Fee $
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 agyees 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.
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c a Use of Premises—/ F N�
h Owner_ Address: _
By Address
ONTRACTOR, AGE r WILLIAM D. BENEVICH
Phone Approved
PLUMBING INSPECTOR
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