1071kTION FQR
17 196,'CIV; O
F
LOT
APPLIANCE PERMIT
CUPERTINO
Date LW n i • . ''��,q� 2
L IJFL (J
Application is hereby made to the City
gas appliances as listed on the reverse side he
appliances in accordance with the provisions
of Cupertino, and all other laws applicable t
Use of Premises
AGENT
Permit No.
Fee
of Cupertino for a permit to install
reof, and agrees to install said
of the Plumbing rode of the City
hereto.
m
2