1995LOT NO.. •3
NO. STREET
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:,APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
Date ��� 1I5r � Permit No. /99S
Fees
110 Application is hereby made to the City of Cupertino fora 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 Premise ^�
Address
Bp r. - ':Address/ (/
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Approved a ..
'' PLUMBING INSPECTOR
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