2729/A7 % O �a, - " LOT N6. /
NO. STREET
® o AFjP1�H TION FOR GAS PERMIT
6� OF CUPERTINO
UNAR k_jg� aDa�T�/ (fir p,T 196_ Permit No.
CkT licV` Pn iOL4p Pee $
d�� he City of Cupertino for a permit to install gas pipes
and/or gas appliances as fisted 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 allotherlaws applicable thereto.
Use of Premises
By C . 4rr�
CONTRACTOR, AGENT
Phone% a
State License
Approved
PLUMBING INSPECTOR
of Appliance I Units Fees 11 New
NAME. TYPE
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ... _".5'...�....... ... _..................
DATE INSPECTOR