440 LOT�NO.
1 NO. STREET
APPLICA 10 ,FOR GAS PERMIT
ITY!OF,CUPERTINO
' Date 1 .195— Permit No"5t7 ' _
® - .. Fee
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Apm�i In Is t.7yc�� the City of Cupertino for permit to install gas pipes
an r gas app'ances as liste 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
oCffjYrti0Fan,(PJl PERT4N&plicable thereto.
Use of Premises n!i L.Y X�",PoLt
, N Owner eg4i F. Address
By Address)
CONTRACTOR, AGRNT /
Phone L r S- Z r g'L i Approved
PLUMBING INSPECTOR��
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