293 ` O LOTNO.
NO. '' T Idl ' 61 d.Gre.ens
A ,:PLIC1A � OR APPLIANCE PERMIT
Kf N0V 5 �TY OF CUPERTINO
Date—. 11�3,1.G0._.,. 196--... Permit No. �L /13
I
41! IV. ot CUPER 11140
Fee E—/
aApplication is hereby made to the City of Cupertino for a permit to install
qgas 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.
Use of Premises Res .
u towner Rousseau Org. _ Addr 2 et St.
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AN CA 5 GHGFT—MET/41 WBR�C�tt•E, 1 Address
779 OLD COlfi:'T�aRTRb nceNr
'' ,r���,,,• ARLOs, CAHFGa.a�A Appro
�Rc.[py�✓ PLUNGING INSP8G7
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