1066 -'el) LOT NO. Z
�PgPLICAT1610 FI R! APPLIANCE PERMIT
�! DEC 17 1962C1u F CUPERTINO
DatePermit No. U `�
IY �; F TIN Fees
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 lode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises_/�/��c /
Owner l��4. 9( �Q� _ Address *INSIICT,
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Address
CONTRACTOR, AGENT
hone_ Z-A6a U Approved
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