1291 LOT.NO: ly 19
✓`NO. ®® STREET, 17ti
A'PPsLicATI 41FORAPPLIANCE PERMIT
IJUN 24 /1963 CITY OF CUPERTINO
Drte ( —.�.� 196-3 Permit No.—'42a9 /_
1 a Y Ur W.
� fLSI Fees 7%off
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 rode of the City
of Cupertino, and all other laws applicable thereto.
a Use of Premises
A Owner � �� �! '4) Address lcg v �
B Address If/
CONTRACTOR, AGENT
Phone—Z03 �/a-7 7 Approved
1 PLUMBING INSPECTOR
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