900I otI
'AUG 9
LOT
-FOR APPLCANCE PERMIT
3TY OF CUPERTINO
Dat CurrNO
CITY I
Permit No. R 00
$D
Fee S R1
Application is hereby made to the City of Cupertino for a permit to install
dappliances as listed on the reverse side hereof, and agrees to install said
appliances in"accordance with the provisions of the Plumbing code of the City
of Cupertiiio,'ana otherlawsapp�ji<a�ble thereto.
Use of Premises ' Ok'A�
W t�. `.
- � Address_
AddressX ; W
M�A" CONTEACTOa, AGEpNT �
L 2 �� Y f Approved
PLUMBING INSPECT
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