2536 oZl`7to4o I `0� 1� 4u�s a,Ve,)we • 'LOT NO.
NO�Z��STREr P,.T�
N d Al PPLIC'ATION FOR GAS PERMIT
z — ppCITY OF CUPERTINO
p ' AUG 21 1963 ,jf '
Y �
3 LL �� 36
Dat!Y O �I ��`kyr^ 1963 Permit No. .�'
Pee$
0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i H and/or Appliances in accordance with the provisions of the Plumbing Code of the City
a W of Cupertino, and all other laws applicable thereto.
r
LL Use of Premises j els _k Orwe�
00
o a Owner -+�`tV (� �ivv.�l.n 9 Address
z0 By— �T
J
O y CONTRACTOR, AGENT M Address
3 �
— m Phone �7i^S� �flll
W z
W W
�s State License __�� Approved
4 PLUMBING INSPECTOR
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