51140P OS tES /3La5s or, A N LOT NO,
NO. STREET
N a�APP�L�I/KATION FOR GAS PERMIT
-z `- ® C, I"�Y OF CUPERTINO
wZ C^II�IG';
K MAY 18 1965
Y ° r
° < Date 196— Permit No.
Q
= U C� i
OF . �U�ER�INO
Pee' $�
° �p icatt n Is here y ma a to the City of Cupertino for a permit to install gas pipes
o and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
a and/or appliances in accordance with the provisions of the Plumbing Code of the City
a m of Cupertino, and all other law, applicable thereto.
00 Use of Premises
o < Owner 0, %9BL
AIPRn T /'ilC/���-S Address �ySS/S oSS01 A, ^'
zJ
Z By ()WAvFR
° CONTRACTOR, AGENT
3�
—0 Phone AZ,2— S
a z
Ra
< o'` State License
—0
Address 5�9'Vf—
Approved
PLUMBING INSPECTOR
of Appliance I Units Fees 11 New
NAME
HOUSE GAS PIPING
Number of Outlets ].-Size of Main
Gas Piping Fees
Tested and Approved .
DATE