1420 O IO / w.2eLfw1 Lf'wi • LOT NO.
NO'
s� STRRBT ,,
APPLICATION LFOR APPLIANCE PERMIT
Mil AUG 27 1963 CITY OF CUPERTINO
DaZ.O.. 196-.3- Permit No.
4d
196-.3-
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Pee 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
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of Cupertino, and all other laws applicable thereto.
appliances in accordance with the provisions of the Plumbing code of the City
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8 Use of Premiises"
Owner � QHS �Q� O
Address T�—�.�GtLe
By 2.— i -1Zl—any' Address
CONTRACTOR, AGEN'!K�
Phoner�1— S�o2o'Z.3 Approved �
l" PLUMBING INSPECTOR '��
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