1813 o� O►-,;% G:A LC L AIE LOT NO.
NO. - STReeT
® fflftlC� FOR GAS PERMIT
� l,�y, {n� C q UPERTINO
Date .��..�, I1�UIL�V 1962 15�11_ Permit No. ' U
I` CITY OF CUPERTINO Pee s ,o
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.
1--Iq
Use of Premises�C �
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Owner /�4IE y _ Addres- M 0 L
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�1011tS Address
CONTBACTOa AGENT I
Phone C L I 0o, I Approved
IT t PLUMBING INSPe OR
I
lo '71 o= O
00
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