847 LOT NO.
NO. T' STRERT ,
APP0CAyTi0N FOR APPLIANCE PERMIT
Lei-,
Y OF CUPERTINO
1pCDate 7U� t96..... Permit No. M7 .
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A_ = ;. ' INTTlING Fee S
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 app1ic_ble thereto.
.w Use of Premises
Owner— K//�/l/L2.L�/O'�I/� Address
Phone l/'�( — 6- 963 Approve
PLUMBING INSPECTOR
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