51146 (2)a%'�✓ V ��L�i"'1% v"rV LOT
NO. STREET
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
Date 14—Y Permit No.
Fee S
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. n
Use of
V
Owner Address
By Address
CONTRACT T P.NT
Phone i Approved
l PL MBING INSPECTOR
of Appliance I Units Fees
Gas
Miscellaneous
NAME TYPE)
Inspected and Approved ....... _i............................. .............
DATE INSPECTOR
HOUSE GAS PIPING
Number OoeMn
Gas Pipi
— png Fees
—
Tested and Approved ............ --- ---- -............................. ......
DATE INSPECTOR