100025A L i N FOR GAS PERMIT
OFEB 3 196�5g�g� OP CUPERTINO
Date pE 1 U6, / Permit No. w U/
Per $ 1 ^jo
—
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.
Use of
py:5nko HAR,)ivAn_ P�dG Co
CONTRACTOR, AGE t
Phone-24-
State
hone 24 -
State
Address
Address "i $ TpursnN s -T
PLUMBING INSPECT OR
of AvDliance I Units Fees
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping, Fees
Tested and Approved ............... :.:....... _.........
DATE INSPECTOR