1446 LOT NO. _
NO. STREET
PLICATIONS;FOR APPLIANCE PERMIT
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CITY OF CUPERTINO '
Dat196. Permit No. //3 is
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Application is hereby made to the City of Cupertino for a permit to install
gas appliances as liste'd"on the reverse side hereof, and agrees to install said
` appliances in accordance with the provisions of the Plumbing f7ode of the City
I� of Cupertino, and all other laws applicable thereto.
Use of Premises
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By --^ Address r•
CONTRACTOR, AGENT
Phone-//-- f��`1�O APProve
PLUMBING INSPECT
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