1812 (2) LA+J&TNO.
NO. STREET
c PJA
TP- N FOR GAS PERMIT
1r OF CUPERTINO
Date vN0 195_ Permit No._�.__�L_Z
W QF Q4PERTINO Fee $ �o
I atio Is here y 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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:a Use of Premises /'L
in Owne `r, 6)(A
Address Thy
CONTRACTOR, AGP.NT
Phone D 4n� Approved E ` 10
PLUMBING INSPECTO
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