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ApP
PUCAIG'N FOR GAS PERMIT
+�ISEP 12 1963COF CUPERTINO
Date7p��7d�C 3p 1/96_ Permit No.
U I 1 Uf li f��li Pee $ �•' J'—i)
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
Owner
By CONTRACTOR,AGENT
Phone r 36
State License
Address 6'S!. Al- /SA Td
Address
Approved .Ll i
J
PLUMBING INPE
SCTOR i
of Appliance I Units Fees
TYPE
HOUSE GAS PIPING
Number of Outlets I Size of Main 1l
Gas Piping Fees
Tested and Approved ...... L ....................----....................
DATE INSPECTOR