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APPLICATION FOR APPLIANCE PERMIT
AUG 2 7 1963 CII' ✓OF CUPERTINO
3 J
Date— � 196- Permit
!'U DUPER -11 NQ
Fees 00
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.
Use of
Owner t� �_ _
By�����
NTRACTOR, AGENT
Phone��— — �
Address/.
Address"
Approve, 2�
PLUM IND INSPECTOR
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