1052/ A��:/�/ LOT NO. /
/ " NO"' STREET
APPLICATION FOR GAS PERMIT
OF C
Date ® Aa
41,
UN 22-1960 ' LJ
/Ap { ap' rl i reb,Kg to the City o
and/or Iia as1J*n{J:!rfti�rrse
and/or appliances in accordance with the pro
of Cupertino, and all other laws applicable th
v
c
Use of Premises i
:a
v
h Owner
JOE MARAL PLUM13INU
By 3399THE AIAMEDA
bAN�RryL EAf29P.'IGAB[R0R N I A
Phone
UPERTINO
Permit No. �OS�
Fee S
f Cupertino fora permit to install gas pipes
side hereof, and agrees to install said pipes
visions of the Plumbing Code of the City
ereto.
Address /
Approved
PLUMBING INSPECTOR e
of Aooliance I Units Fees
Gas
Inspected and Approved .............. :....... _........... ....... .......... .............
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets y Size of Main
Gas Piping Fees
_�_._
Tested and Approved ..... _� �.... ....
SATE INSPECTOR