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Ce-7 '� /i✓l_ � _ LOT No. P
NO. ISTREET"'
APPLICATION FOR APPLIANCE PERMIT
•`" '� OCTTY OF CUPERTINO
C
Date= '' ;- ? ' r, 196. — Permit No.
I Fee $10' o )
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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 rode of the City
of Cupertino, and
alall
/other laws applicable thereto.
Use of Fre,(mises
�
ti Owner(/`� ` _tp'Che- 66� Addr #/ �n
By— 2li Addres I 7-7Qr7);
/l CONTRACTOR, AGENT
Phone ✓4 '�-'1 to J AC Approve / .
PLUMBING INSPECTOR
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