2449 No. STREET '
APPLICATION FOW GAS,iPERMIT
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3 < Date ill_'t a-sI " 196-42' . :�„ Permit No.
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Application is'hereby made to the City of Cupertino for a permit to install gas pipes
`o r and/or gas appliances as listed on the'reverse.side hereof„and agrees to install said pipes
1, i in and/or appliances'in accordance with the provisions of the Plumbing Code of the City
Q w of Cupertino, and all other laws applicable thereto:
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3 Owner ktMt-RAN CHURCP Address `
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0 CONTRACTOR, AGENT
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PLUMBING INSPECTOR _1 '
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