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Cil ON FOR GAS PERMIT
OF CUPERTINO
Date 195_ Permit No. 1
CITY OF. CUPERTINO Fee SI-1 fD6
J) Application is hereby made to the City of Cupertino for a permit to installg`as pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to installfsaid pipes
and/or appliances in accordance with the provisions of the Plumbing Code ,oLf,the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
A OwnerCZ Address
\Address
C ACTOR, AGENT-� n
1 .yPhone C — I Approved
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� PLUMBING INSPECT
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