1448 No., �� STREET
APPLICATION FOR APPLIANCE PERMIT
��,,��,, CITY OF CUPERTINO
Date ' Co 196. Permit No.___L�
Fee 1 U'
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 f:ode of the City
of Cupertino, and all other laws applicable thereto.
7 Use of Premises lll=�G- -eK
`n Ownhr /r�� 5 Addres� /
By�Ca. 3E' .� Address —`-
^�n CONTRACTOR, AGENT c
Phoned t ' Ilr rJ�� Approve
PLUMBING INSPBCTO
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