2730LOT NO.
,Pu�c N FOR GAS PERMIT
a V�
OF CUPERTINO
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0 o I MARS X964: , / 3
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3 U Date CITY F .196_ Permit No.
CIT licaOF isQU ff U fflthe Cit of Cu ertino for rermit t�nstall a pipes
PP Y Y P P g. I P
`o 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
i W of Cupertino, and all other laws applicable thereto.
Use of Premises
00
3
Owner Address
Address
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Z
ByC°..�-c-�t' Address
3 0 CONTRACTOR, AGENT
a Phone �`�S .� 3,13
N
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z&/,�
0 o State Licens I�(< Approve
PLUMBING INSPECTOR
I HOUSE GAS PIPING
Number of Outlets Size of Main �/ L71
Gas Piping Fees
Tested and Approved . . . . ........
DATE INSPECTOR I