1489�Nd �STRBET `
J�,� N�V`�AA�R�I AI •ION FOR GAS
CITY OF CUPERTINO
�ITYN�i�-GLIPERTINO
LOT NO.
PERMIT
Da , 195_ Permit
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.
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Use of Premises A
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4Z Owner f( f4ft C-)( N0HC-S Addresl'i JVD q e I1�rt
By W I CbEq—�1OQ -S Address -O "<
��LL(L CONTRACTOR, AGENT
h e l OLEd 1� Approve
MBI
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PLUN
GG INSPRO Oft
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