272 LOT NO.— #I 38
ryo. STREET ^_ - IdI'HWild
APPLICATAN `FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date 9/234;0 196..... Permit No. C:5? 4'
Fee $
Application is hereby made to the City of Cupertino for a permit to install
p gas appliances as listed on the reverse sidj hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing r',ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises Rag _
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r Owner Rousseau Org. _ Address 2 �' r et S
SAN %RLOS SWET METAL WORKS, Nr Address
774 C V' CCdkffACTOBy+AGENT (-1.�`l, �l.0
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Pfiolic C.edl:5. CaLiFO"nti{A Approv -
J. Jo.„f. ` — , PLUMa1NG INSPECEOR
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