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APPLICATI N F APPLIANCE PERMIT
VAN 24 iS61crVotbF CUPERTINO
Date J—. ),Inrnr1,%06. _ Permit No.
LI7�
M1 * V IY . 4U LI\lilw / SO
�Q Fee $
Application is hereby made to the City of Cupertino for a permit to install
p gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
r7 Owner — Address.zZQ��/Cx i "
By f Address_Q 4
c NTancroa noeNr
Approved
PLUMBING INSPa 0.
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