1288 ,J 4
LOT NO. /
NO. . j�sinuis
� � �I
PPLICATION FORAPPLIANCE PERMIT
l' IJUN 24 9963 CPTS'zbF CUPERTINO ,X/
Date—,,A�t-st r -n�-�-n�'�„i�l'9G-3 Permit No.�”
-�i V I-�—
Fee E_ 7
tApplication 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 rode of the City
y of Cupertino, and all other laws applicable thereto.
u
Use of Premises�xsr�/�i,�
i � D�� �� +-CtoCr
OwneA 1 '� Address 71
OOi
B Address
CONTRA
CTOR, A
Phone ,Z. y Approved
PLUMBING INSPECTOR
MI n I s,� C)
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