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y •14�Lr;',.�:APPLICATION FOR GAS PERMIT - -
:� CITY OF CUPERTINO
0� AR
Date 195_ Permit,No.
<CITY OF CUPERTINO Pee $
a 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 ofyhe Plumbing,Code of the City..
of Cupertino, and all,other laws applicable thereto.
Use of Premises-.. �7�f�1 ( .y��2i> .
a \Y�//
in Owner ��L//SCl!d / Address
By Address
/ CONTRACTORLG, AGENT �j�
Phone/14 3 — i Approved
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' PLUMBING INSPECTOR
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