2172 (2) oZLLdSt/ i�x/w-.Zf iw D LOT NO.
NO. _T STREET
N < asA P ICA TON FOR GAS PERMIT
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P CUPERTINO
ML Y 996
3 ¢ Date 196— Permit No. I 7�
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0, �Hpl!ation�ils herCbylm�ada to�the�City of Cupertino for a permit to�stall gus'pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
a of Cupertino, and all other lawsjApplicable thereto.
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3 Owner Address
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O CONTRACTOR,AGENT
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oState License—. Approved
U PLUMBING INSPECTOR
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