1429 (2) ?0?0 y ' �- LOT NO. �[J
NO. STRR \j ..
Li T FOR GAS PERMIT
Y ° I • CUPERTINO
SEP 2 6 1961
�1 Date _ Permit No.
�l $
n . CITY OF CUPERTINO 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 agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
i V of Cupertino, and all other laws applicable thereto.
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Use of Premises �n
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I A Owner izt.e Address
By' Ajez e Address �1
/ COMA ACTOR, AGP.N �.
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PLUMBING INSPECTOR
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