51158 (7)LOT
NO. - 511tebr
PL CATtiION FOR GAS PERMIT
?/�
[�'y� � F CUPERTINO
CDate ! 8L .�6J 19 Permit No.
Fee $
A% Ytio0FheGQPE,RT4NCcity 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
�%
OwneL /F,-, ZI 7
Address 1
Idress�r
proved /
jPL .IRINC INSPECTOR /
of Aoaliance I Units Fees
maces
NAME TYP
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Testedand Approved ..-------------_..----....__._._................_........._..-
DATE INSPECTOR