934 j S'.'2+,fY ::k: ,1.,. ./ f ,• LOT NO. N-n
Nti,-,.'t. _. STREET .
APPLICATION FOR GAS PERMIT
eCITY OF CUPERTINO
,jDat195_ Permit No.\19 / T
1_••
.• p.[..p Fees s(j�
TY 0App i%a), d- Je1K9made 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 of the Plumbing Code of the City
of Cupertino; and all other laws applicable thereto. ,
:a
Use of Premises- ......
Address
By�—T���l//�G Address '&oz
CONTRACTOR AGENT
Phonee'�— 3 Q(// Approved ✓
PLUMBING INSPECTOR I
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