51172103026
NQ
Z z
W�
®(OCT 26
N FOR GAS PERMIT
OF CUPERTINO
l tt /G ? '- l9G— Permit No. ri�� % L
Per $ fZ
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 othMlaws applicable thereto.
Use of Premises f/ //6,661/"zt'/L.VV V
Owner --t ( 2 ✓�.G /��` Address�03%G
Address KJ
Approvedt c c li
PLUMBING INSPECTOR V
of Appliance I Units Fees
Heaters
E TYPE
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees .�
Tested and Approved ........... ..... ................
DATE. INSPECTOR