2009 (2) 1 /
CJ� Q-C7 t3:6:. ,�/�-CC.f LOT NO. �..
No., eeT
�PpL
ATS ON FOR GAS PERMIT
�;l SEP 5 1962cl ! OF CUPERTINO
9EISEP
'Date ` � 14-x— Permit No. C9 O C7
9
CITY 0 CUPERTINO Fee $ 3"S-0
Application is hereby made to the City of Cupertino for a permit to install gaspipes
A 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.
c
' Use of Premises .lt�
u !
Owner d;? Oec Address%9 �• � �
�.
By (7Y,-( ay Address
CONTRACTOR, AGE
Phone " ' ,1 /rL� it
, Approved
! PLUMBING INSPECT
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