485 LOT NO.
NO. s II
® CIjAPPLIANCE, PERMIT
F CUPERTINODate ' R� AD 6..... Permit No. u,
C4TY OF CUPERTINO Fee $
App ication Is hereby made to the City 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 f7ode of the City
of Cupertino, and all other haws applicable thereto.
Use of Premises 1 -za' 4k e $
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Owner( 1 vl p ��f LI-'-- Address
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