2731la�
/ % - LOT No. �O
V(M4fkzvMIf1Y0N
FOR GAS PERMIT
AR 4' 1964OF CUPERTINO
1:0 /1F /t,OrONG 196 `/ Permit No.
1
Per$
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
By
CONTRACTOR,AGENT
Phone ' S a 3 -.13
State License IA& �
Approve
PLUMBING INSPECTOR
of Atvlianoe I Units Fees 11 New
NAME. TYP
HOUSE GAS PIP NG -
Number of Outlets ize of Main
Gas Piping Fees /
Tested and Approved .... .. .._ ...... ..... ._.........................
D TE I INSP GTOR