2696/D 4-,7 I Lr'+��T��^-�J^ f/�V - LOT NO. �� a
NO
.' 3®5 �
m ;APPL"ICATION FOR GAS PERMIT
< CITY OP CUPERTINO
W 2 8 1964 t
f 0
y O L/L
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° a Dale . -��1.96?L Permit No.
3 LL L, I OF C5:7 Ut't •' Pee•$ �_
° Application is hereby made 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
i m and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
Use of Premises
00
3 Ownere-L,//"n2f1 Address
zBy //� t� Address
° CONTRACTOR,
` AGENT
3Q
— 0 Phone
w z
oState Licenser Approved
- U PLUMBING �INSPECTOR
of ADDlianCe I Units Fees
NAME. TYPE.
HOUSE GAS PIPING
Number of Outlets a Size of Main 3/
Gas Piping Fees
Tested and Approved..�.-..3'���..... _.......................
DATE INSPECTOR