1992 (2) /. 3 l LOT NO. 'Y NO. STREET�.
AFL&IG�P4TION FOR GAS PERMIT
CI OF CUPERTINO
AUG 3 0 1962 '.
Date �"�+C' Permit No. 9 /
CITY Or ClUIDERTINO Fees J. '5�0
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
l4 and/or appliances in accordance with the provisions of the Plumbing Code of the City
\ of Cupertino, and all other laws applicable thereto.
u
.� Use of Premises '
Ii Owner 16�e _ -C� q Address
Addres 40vc Cc „y
CONTRACTOR, AGENT 7
Phone(-�071 9"497 t APProv
i UMBING'INSPECTOR
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