2589LOT NO.
Q `jq1 F/STR�ET-� LICTION FOR GAS PERMIT
qY OF, CUPERTINO
l OGT 3 9963
Date �� (' 1963 Permit No.
CITY 0 1..,�j Fee$
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 : ,4
A
�1411 01104 Far,
of Appliance I Units Fees
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ..%..-i.b.'..�.�. /t. �.....................
DATE INSPECTOR