551 �/ p
O 2 �O �LOT NO.�
NO ET
APPLIANCE PERMIT
AUG c tyF CUPERTINO
11
Date 196.....E Permit No.
CITY E CUPERTINO Fee a I '?
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 bode of the City
of Cupertino, and all other laws applicable thereto.
I �C
Use of Pr ises_SG[
17i Own �»r./-ave '& / Address
LWAddress
/ TING & S,H....'�7AOa6NncENa i
4p}9pgt.: Approve
PLUMBING INSPEi
a
m 3
. n
0
<'
—————— ————————— ——
n Ci r�
z