2796LOT NO.
V I. N FOR GAS PERMIT
i C cOF CUPERTINO
'APR 241964 �-
3 a Date 196— Permit No. �� /
U ��;; TTYY n(��� II�II f� R{ 7
° t plp )atld5'�s &I'PtltYde� AQ City of Cupertino for a permit to install gas pipes
'o r and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
r and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertm and *1awsable ereto.
0 oUse of Peses
Owner ' ' -- u.Address
ZJBy - ���d^— Address-
CONTRACTOR,
ddress /
° CONTRACTOR, AGENT
— '
z Phone
w w fid-' 4 KI(f Aj
s State License —"`''�v Approae
-`u° /
of Annliance I Units Fees
HOUSE GAS PIPING
Tested and Approved