699 ' lrc LOT NO.
NO. STREET
OR APPLIANCE PtRMIT
EF OF CUPERTINO
B 8 1962Date A" 3 0 1962 196..... Permit No.�/ _
CITY OF CUPERTINO Fee a / S=
O 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 Premises4,t4 tr_
uyq /
r7i Owner +.( �.u, _ Address .�
By_ urnT .R U Address
190 E. suetgfn,AaJORc,^SS Tt, CA,
Phone Approvev
PLUMBING INSPECTOR
) 2r) C) In
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