2699/OY�� •�C7*rJ��y �- - LOT NO.
NO � STREET � •
APPLICATION FOR GAS PERMIT
/FES 28 1964 CtI7;OF CUPERTINO
rM. ,
Date �•� �•��!PER i tL96? -Permit No.
Pee $
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.
Use of Premises
OwnerAddress
By �� l
B CONTA CTUR, AGENT Address
Phone S -�2
State License •S ! Approve TT
� �UR
of Aoolianre I Units Fees
TYPE
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Appro, ..............
DATE INSPECTOR