27895�
LOT NO.
APPLIC pk?N FOR GAS PERMIT
APR 17 1964 'cL1% OF CUPERTINO
DarL,.t�""" T: 1119( Permit No.
I+II f v4'f c�.
Fee $ 375
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
w ?%Phon
WW
W
o ; State License Approved
_0
�14
D' PLUMBING INSPECTOR
of Appliance I Units Fees
NAME TYPE)
HOUSE GAS
Tested and Approved .. ...'C.....'......1._,..✓...---..lt.............