2047r
-1
LOT NO -
kS PERMIT
NO
Permit
No.2 Q -5
z 7
3 �'O
Fee S o�
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 of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
Owner �.CG`G=.0 G!%/<Gf� Address 9 C�S llC�G
By Addres J7 e,�4-
CONTRACTOR' AGENT
Phone = G .S— _ Approv
MHING INSPECTOR
Gas
of ADDliance I Units Fees
NAME
Inspected and Approved ..............:...�
DATA �...............'rNSPECTOR ...............
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ..... ...��..... . ..............................
DATE INSPECTOR