2697LOT NO.
1117/ APPLICATION FOR GAS PERMIT
(FEB 28 1964 CITY OF CUPERTINO
Date — �` ° `„ 196 Permit No.
CI -1Y DF L11FL:. '' 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 np�'
Owner�i�t>��yr— Address
By Address
CONTRACTOR, AGENT
Phone �'ti.�r' --.7 9'23
State License �'S I Approved
PLUMBING INSPECTOR
of Aooliance I Units Fees 11 New
MF.
HOUSE GAS PIPING
Number of Outlets Size of Main L
Gas Piping Fees I
Tested and Approved .. / ... . .. ..... ..................
DATE INSPECTOR