1289 LOT'NO. /17
.NO. ZQ S VIV
APPLICATION ,FOR APPLIANCE PERMIT
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,1 J U N 24 1963 t CITY OF CUPERTINO
Dte�= -- 196.-3 Permit No.
J
I'7 Fee
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.
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Use of Premises
ti Owner Address—]
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BY �l1/ Address G.vt-
ONTRACTOR, AGENT r
Phone 1— '/S� Approved_ L
PLUMBING INSPECTOR
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