1245 LOT NO._
Nn STREET
011MAY
PLICA`�•ION TFOR APPLIANCE PERMIT
CITY OF CUPERTINO
2 1963 V;.
IDate — --2 196. Permit No.--- a-4
CITY OF CUPERT `\'^ 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 said
V appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
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per Address�
By- Address
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Approved
PLUNGING �NSPLGTO.. ,/
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