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APPLICATION FOR APPLIANCE PERMIT
_ CITY OF CUPERTINO
Date API a1 Permit No.�
trf APR 2119611 Fee a ,3°
Application is hereby made to the City of Cupertino for a permit to install
gas appliancp5 �- to n t lq��4� �(�p(areof, and agrees to install said
appliances i rda wt L e roviswns of the Plumbing rode of the City
of Cupertino, and all otherlawsapplicable thereto.
Use of Pr ises 6��j ri (�V/u k
Ownt,' NjKJ'O.,t,tai Address
By DIVT"ION Address__ 2
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�� Yf;TBEk�I1NNY0AKS AVE. CPMP^P' Approve '
PLUMBING INSPBCr R
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