1157 LOT NO._
NO. STREET
(APPLICATION FOR APPLIANCE PERMIT
CIRIOF CUPERTINO
Date-
1963. Permit No. /1Z 7
CITY OF CUPERTINO Fee s_.7'
l� 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 code of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises
in Owner`��LClL _ Address_
A?0?� j Address
CONTRACTOR, -f
Phone�c3�L�y�s� Approve /M
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PLUMBING INS H
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