1210c�
a,
LOT No.
NO: • STREET
APPLICATION FOR APPLIANCE PERMIT
.VAY 'CITY OF CUPERTINO
Date,' r r S_• - . 196-3 Permit No. �a
Fee S iN
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 bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
Owner_
i yi
7l Faf �s
Address
Address
Approve
PLUMBING INSPECTOR
ot
'O
O
o(d
-----------------
TJ