879;:.�,' I L' lam/ /✓� LOT NO. f�
-NOBTR00
,k; ,'•_. ° APPLICAT ON FOR GAS PERMIT
itpe 1 CI'1FY OF CUPERTINO'
Date e -e l D / 195.9 Permit No. '
CITY OF. CUPERTINO
Fee $ r
�i Application is hereby made to the City of Cupertino for a permit'to irstall'gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to instail,#d 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
v
�n Owner v, Oct Address '
/ 1 -2 � 9 c C.'o •.z..'T-� R'cl�
By F,crn. 6110-r �tr7 41 r7<( Address -< t f r,/ar
CONTRACTOR, AGENT
Phone /P� -6-•J"J 7 y Approve �t� X ��—
PLUMBING INSPECTOR
L'00,
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