2415 (2)NO. STREET
APPLICATION FOR GAS
w CITY OF CUPERTINO
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LOT NO.
PERMIT
3 ¢
Date _ I� Permit No,
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Pee $
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 a gees to Install said pl >es
and/or appliances in accordance with the provisions of the $mbin� Code of the/C.��ty
of Cupertino, and all other laws applicable thereto. �(
Use of Premises
Owner Z&,b 1/6S 9,/Gti!?1yJ
By //��
CONTRACTO ,AGENT
Phone i � 'K:55
State License
Address O u
Approved
PLUMBING
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