1442 /03.3
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LOT NO.
NO. STREET
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date —,�P c� 1963Permit No. ZZZ
Fee $ ,9 ��
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 lode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
By Sc'—nz e--r AdlikAddress - �M% YfJ,7 P
CONTRACTOR, AGRNT .. /
Phone 1>69 4— 1(c,910 Approv L L v
r� PLUMBING INSPa OR
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