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NO. ��STREET
® l.�P��'� ATION FOR GAS PERMIT
T O 2 G CITY OF CUPERTINO
Dat ot3 — 1957. Permit No.V
1
i CITY OF CUPERTINO Fee $ i 4j�
Application is hereby made to the City of Cupertino for a 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.
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Use of Premises A"i �c e AZI h
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Owner
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'By A`lll� .4 �Nc•• I Address
CONTRACT R, AGO ENT
Phone— 6 X963 Approv t
1 ' 1 i PLUMBING INSPECTOR
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