1421 as �a,G •" - LOT NO. 0^
NO. � STRHET�
APPLICATION`.! FOR APPLIANCE PERMIT
I/m G 27 1963 1.'XITY OF CUPERTINO
1 Datt- 011-i`n 3 1963 . Permit No.
J",J Lt 1 i f L 1 l7Vt_4 -
n� Fees G. So
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 applicable thereto.
V
Use of Premises
m
in Owner Address _
B Address -
s C ACTOR, AGENT
Phone Approved s
PLUMBING INSPECTOR
M 0
D
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