1282IAT NO
.rt0 •. -'�,,, STREET
APPLICATION FOR GAS�PERMIT
CITY OF_,^ UPERTINO e
Date
43 lWy�/,
.Permit No._
. ..
� a�z
Fees 112'—
Application
12.—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 agrees to install said pipes
and/or appliances, in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
E , Use of Premises
JS +; Owners. _ Address:.
aa� By . Address
i CO ACTOR, AGENT
Phone Llo , % 5'-r " Approved
/Z '1 •PLUMBING INSPECTOR
P,IwiC'LH' Ir,' .
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