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LOT NO. 107
NO. STREET
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APPLICATION FOR APPLIANCE PERMIT
[ FOR
�D�C 9 1963 CITY;OP CUPERTINO
Date- - 4- Deo ,.196'.x... Permit No. /3" /
0I 1 1NtN'
Pee s _7__
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 code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises Ree
Ward Crump- Dev
Owner _
Sa� Carlos NSJThaG,1t/C� Mtl Wks
Phone 591 ` 6r�R, AGBNr
I
P.O. Box 634
Address
Address 779 Old County Lid.
Aooroved S. C.
PLUMBING INSPECTOR
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