980 0 G •✓ LOT NO.
NO.
FOR APPLOANCE PERMIT
1 feu OF CUPERTINO
OCT 10 1952 ;
Date 196..... Permit No.
OV
CITY OF W E �a
Fee 1_
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 all other laws applicable thereto.
Use of Premises �t
u '
Owner �� % Address_
By DIVISION Address_
HEATING & SHEE9NMEWFB(f,GBNr
180 EpSgtj YOAK$ AVE CAMPS fAl a APProv _ -
PLUMBING INSP
0
n. �
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AN
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