1132 /O 6,57,51- LLL LOT NO. /
NO.`��\ ISTREET
'�I t APPLICATION, FOR APPLIANCE PERMIT
SAP) CITY OF CUPERTINO
Date_ _ 196..... Permit No.
00
Fees 6
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
Owner _ Address
n —
BY Address
' coNTRl;croR, nceNr '
Ph ` '�� Approved
PLUMBING INSPECTOR
(l c) C1
PX
w 3 ,y7 0
� �. .. n SI w
w
n
v
O N ^
G'
0
o —————— ———————\ ——
————— ———— —
a b
T ,
R ''