268 AU`,C~;t! 02 �+ �� IAT NO. j�eWJ3:ej
0: MEET IT
APPLICATION; FOR APPLIANCE PERMIT
,CITY OF CUPERTINO
/60
Date 9/23r' 19G..... Permit Noc:�?Io
Fee t
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 Res .
Rousseau Org. 2 ret St, S . F,
0i Owner Address _
SAN I�hRLOS SHEET METAL WORKS, MANk Address
} 779 OLD QOMNWTWIAaNT
rPh6AN ARLOS CALIFORNIA Approv
PLUMBIN INSP�GT
j
numn�a r
�i�mnu o