1064 /V"6 - / , &. T
NO. iTREHT
AP ICTI0 ,FOR APPLIA CE PERMIT
LVI
TYOF CUPERTINO
INOV291982
Date 196----- Permit No. 110�lq _
CITY OF CUPERTINO Fee $
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
65 OWne _ Addresar%�� iLlntlN ��Gt.Llrl
By Address a
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Phon6 3-2 5 zApproved .deo
PLUMBING INSPECTOR
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