2702F
FEB 2 8 1964
LOT NO.-�,
N FOR GAS PERMIT
OF CUPERTINO
Date nlrsr nRZ;1
P�gd?'ti '.. O` 0�
'{t--, 96— Permit No.
Pee $
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 Premises
t7
Owner !� Address
CONTRACTOR, AGENT
Phone—
State
hone State License
Approved
PLUMBING INSPECTOR
HOUSE GAS PIPING
Number of Outlets ,,7- Size of Main
Gas Piping Fees
Tested and Approved'--
-4- E
DATE tN PECTOR