1258 WSJ G 1 P?,/) , tOT NO.__
NO. 86
F
PLCATION FOR APPLIANCE PERMIT
JUN/ 3 1963 CmOF CUPERTINO
Date 6 196.`3 Permit No.�
CITY Uf CUPERTIM Fee : J 6 0
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 f:ode of the City
y of Cupertino, and all other laws applicable thereto.
2
Use of Premises
r7i Owner 220 — Address
BYE f" Addres
CO a. AGaNT
Phon P. G(/z/ Approve
PLuwuNG �N9PlOTOa
v � n
0
n
n
_ o
---
-------------
-
------- ----
-————— ————————
Z �G�
v n
o
P