477 0 I � LOT No.
NO.' s B
APPLIC N FOR APPLIANCE PERMIT
® C CUPERTINO
4 L
Date_ 961 Permit No. z—
Fee S
App j* i eb6WP(-qf of Cupertino for a permit to install
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.
aUse of Premises; d i AC x
} Owner G�11'� Address
DIVISION Address
HEATING &ct1Nf[xctHBTAfGdllc
P1Sone " F. Approv
PLUMBING INBPB O
+1 0.
� R
0
————————————
m
C
E
o : n An7