1208Id N6 A �/"ZTM O. 82si /, LOT NO.
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date 196.3 Permit No.
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
�p appliances in accordance with the provisions of the Plumbing rode of the City
g of Cupertino, and all other laws applicable thereto.
a Use of Premises �� w . _ ,
or
Owner
Address,-I-.56-'. /�/r611�•
Address
Approved
PLUMBING INSPECTOR
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