1016 �C)I 2A� OT NO. tl
NO. � EIT
�AP<PCATt'ON,.�,N,.�,R APPLIANCE PERMIT
NQtJ 7 1962 !sl3 OF CUPERTINO
Date 0196..... Permit No. G
CITY OF CU S o
Fees
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 wi the Provisions of the Plumbing rode of the City
of Cupertino, and othe laws ap ' e thereto.
Use Pre\mi s �—
7 Owne ry r r _ Address_
B — Address
CONTRA , GBNT
Phone Approv
PL NBI INSPE R
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