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r12x��A-LOT NO._
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/® � APNICATION FOR GAS PERMIT
J CJbTY OF CUPERTINO
l�iyt �u14y19F �"11966 Permit No.
lel OF rllII pp Fee $
Application Q6 S{ to the City of Cupertino for a permit install gas pipes
and/or gas appliances as Ii 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 — j 'Gtl 1/-7 Ht
Own e&- - �i X441
By K /J �C/l� L'—v /600
CONTRACTOR,AGENT
p� e�24/--/360
State
f / OOC N
Address -2
Address d' Prp LLC /%Y9�Hb
.fuci/may vi9-c e
Approved Ldo-2d
PLUMBING INSPECTO
of Aooliance I Units Fees
E TYPE
HOUSE GAS PIPING
Number of Outlets Size of Main
Gu Piping Fees
Tested and Approved ..... -------..__.---r--.--._..__...._.._....._........_.-.
DATE INSPECTOR