1445 /Y, `-�_ '• -��0/ `- LOT NO.
NO. STREHT�
APPLICATION FOR; APPLIANCE PERMIT
u r CITI� OF'CUPERTINO
I Date rIf- ,119C Permit No. Z
Fee $ ��•OC1
Application is hereby made to the City of Cupertino for a permit to install
mgas appliances as listed on the reverse side hereof, and agrees to install said
I appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises -��'1-��'�
_ury �f
r7i Ow Y:S" 6 L-U��S/ / - Address - D • ?--2y ��- - .
C — �—
By )f sC _ - AddressylI 10M
CONTRACTOR, AGENT \
Q� Phone —� Approve
1/ PLUMBING INSPECTOR
C) w`Cl Cll.al C)
M. 0
0
o
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