2348 (2) : ....
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•� No. . .' : STAaa7 ' i• t : ft`.
N d APPLICATION .FOR GAS PERMIT
W ¢ =s' CITY OP'CUPERtINO '
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01 . Date L'' f .1.96 a Permit No.—'
W W /•.r Application is hereby made to the City of Cupertino fora permit to in'stall'gas pipes-
o < " and/or gas,appliance3 as listed on the reverse side hereof, and agrees to install said:pi acs
a �t4 arid/of appliances in'accordance aT'thm the provisions of the Plumbing,Code of•the City','
i W ' of Cupertino, and all•other laws applicable thereto. .t +�'C' tW,n;�': •v .,
0 o Use of Premises C / T AAT t
3 Owner?/jayAf 1, 7hels1wC Address �''r.'• ••
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Z By ��f 7 ��iq//e v f���J G• Address � 30X_.5 1
– m Phonae'/1
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otate f Liccnse,-0C'�7.-'d• L%' ! {�.
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' Approve
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