758/,0/ 9a
NO. STREET
APP ICN APPLIANCE PERMIT
® •UPERTINO
Date 4 1 Permit No. _/ (23 J_
(ITV (�[ (���p[pT n' / 00
1 •Yak'6r RQ . Medd 4diJJNP Fee E �in '
Apph R is Eby._ _ e of Cupertino for a permit to install.`
gas -app lianceras listed omthe reverse side hereof, and agrees -to install said
"appliances in accordance with the provisions of .the Plumbing':ode of the City
of3Cup'ertino, and all other laws a hcable.thereto., R ? -'
yq r,
Use of Premises S ` •_
x y
ROTH SHEET METAL'"<�l�C
OwneRddress'
22413 MEEKLAND AVENUE
CONTRACTOR,•AGENT , - fiAr W AKU
-Ct- 2. 3 ;.a0 •o : Anprove
5
n
G1
C)
m
n
C)
�o
'a@ 'O
QQ
�x2vC.�
a
ij
1'a