1270 O �! 3 ^I LOT NO.
® A'PP IV^MATI AOR APPLIANCE PERMIT
,Ii! JUN 1 !1 1� 301 OF CUPERTINO
Date 196. Permit No.—
CIT
o.CITY OF CU ERPNO o0
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Fee
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1 Application is hereby made to the City of Cupertino fQ a t�11�to
gas appliances as listed on the reverse side hereof, and agre8s-Lq_i tall said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, andel all other laws applicable thereto. t
Use of Premises
in Owner] Q�Ri\ t-A 6.5 _ gPLUM,
O JV-f[�7D�_
Address
Byer-- X14-i/ , Address7
CON .ACTOa, AGPNT
Phone_ ! ZC. 7 Approve
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