2275 (2) w �" G �'" U •I lei 6ljWOO M GT LOT NO.
NO. STREET
N < APPLICATION FOR GAS PERMIT
z Z CITY OF CUPERTINO
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3 U Date
1.962 Permit No—
Fee
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Application is;hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i on and/or appliances in accordance with the provisions of the Plumbing Code of the City
Q w of Cupertino, and all other laws applicable thereto.
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Owner_Use of Premises
> l 11040 i V� /&
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a' By Z';r J' i���✓ �/h// (� Address 4r��7'i �—/p lr
�,., CONTRACTOR,AGENT
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°a ate License `7 �.� tfi Approved
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