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R CGNAITION �jOR APPLIANCE PERMIT
MAY 2 4 9963 . OF CUPERTINO
I Date 196-.3 Permit No.
CITY OF CUPERTi111O Fee $
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 code of the City
of Cupertino, and all other laws applicable thereto. ;
aUse of Premises
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Owner Address
Y Address
CONTRACTOR, AGEN
cone ��j2 3 I' I Approved
PLUMBING IN P8
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