51145 (5)�I4II I �A �Y/� CT LOT NO.SWEA
J-.�O
AAPP 11 ION FOR GAS PERMIT
z ` OF CUPERTINO
x o VJUL — 8 1966
3 u [) J -//Ware 196— Permit NoJ-//W= LL CITY OF CUPERTINO Fee 8
0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
`o i 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
w of Cupertino, and all other laws applicable thereto.
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Use of Premises
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>3 Owner%t�/,�'gZGL%7gn Addresszj
Z By /Y'/ r—f'�"/ � Addressd3?5S o/' 7
O CONTRACTOR,AGENT
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— 0 Phone
070 tate License �.�3�3 Approved;:,;;- j
_ U4 PLUS DINC INSPECTOR ✓
of Appliance I Units Fees 11 New
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees -
Tested and Approved ............ ........
DATE INSPECTOR