100014WZ]LOT NO.
NO. T EET
APPLICATION FOR GAS PERMIT
iz a CITY OF CUPERTINO
-
Date 3' 190LC Permit No.//.L') d' e//
Per$ L\3 SZ
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/or gas applianc as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances-ccordance 11 the provisions of the Plumbing Code of the City
of Cuuertino, and all ther laws oicable thereto.
Use of
of Appliance I Units Fees
HOUSE GAS PIPING
Number of Outlets j Size of Mai
Gas Piping Fees
Tested and Approved ...........1.1/4....... ........................
DAT INSPECTOR
r