15933S3 ,
NO. STREET
im &
APPLICATION FOR. APPLIANCE PERMIT
CITY OF CUPERTINO
Date DEC 'L 0 1963 , 196----- Permit No. J
„ 1 sFeet
Application is hereby made to the City of Cupertino fora 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 rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises --c.
Owner (Mm )h�
WNIR AC"IOR, AGE
NT
SHEET METAL
Co-
Address't% /--
Address__
Approved
PLUR_
NG INSPRCTDR
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