982 4 /:q qz] ` , 1 C 1 e 1 l t�1I •\\\ LOT'No.
N . STREET
P: S MIG N FOR APPLIANCE PERMIT
i OF CUPERTINO
P1�
09T 11962
Date ell9 196..._ Permit No. a Z
CITY OF CUPERTINO
Fee $
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 code of the City
y of Cupertino, andall
pother laws applicable thereto.
VUse of Premises Ja uP It-X
OIWQ(�`,� tk J _ Address _
BY / �/c`� �a Address 7 Sit cc/waoc
coNTRACroa GENr
C( Phone 197 6 —i]S'R Approved
PLOM0ING "SPE R
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