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LOT NO. 51
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APPLICATIO J?R APPLIANCE PERMIT
JUN 4 9964L rY OF CUPERTINO
> a TV�9AC y/�I IN In
, 196..... Permit No.
f wu�
Fee $
Application 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 rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises Res
Owner Ward Crump
fy bs J11CC4.MQK1
779 Old Countjiil>WCToa, AGENT
P t9fbs-,�
IT
Address P. 0. Box #634
Address
Approve Cyt
PLUMBING INSPB OB
1
'-Gas-
ME
Gas
of Auuilance I Units Fees
ME TYPE
Inspected and Approved .`jr0'Y;...._. .. ......................
DATE INSPErTOX _ _ _