1075 •NO. STREET
N -dAPP,LICAT ON--FOR APPLIAN E PERMIT
CIS OF CUPERTINO
91962 �o ���
Date 196.-? Permit No.
Co"' fY Gr CUPERTINO Fee s
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 slid
\ appliances in accordance with the provisions of the Plumbing rode of the City
4 of Cupertino, and all oth r laws applicable thereto.
2 e
Use of Premises C.
cLC/
Owner ] �.�Gpp
Address .^r..oa•/l�
By Address
CONTRACT_00., AGENT
Phone�J� .� S oZ� Approved
. PLUMBING INSPECTOR
o. � � � m � � � .-� R g d n _ °' .'fie� ❑ o
> n
ot
o,
—
-------- ------ — — N.
z
E �
^
3
—w
9 ^
I b
0
i