662 LOT NO. .ZS
NO. T APPLIANCE PERMIT
IDEC 2 C CUPERTINO
9 '�sr
Date DEC 2 8 1961' Permit No
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TY, OF CUPERT`nn''19G
�IY� Fee S
~ ^+•t*A•pplication is hereby made to the City of Cupertino fora permit to install
gas;appliancesias listed on the reverse side hereof, and agrees to install said
{ app:iaeces in accordance with the provisions of the Plumbing rode of the City -.
Cupertino, and all other laws applicable thereto.
Use of Premises
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, Owner _ Address
. �y Address
A I ,,�/ L11
I.F :.;IE5�NGG SHEET I ``G�® Approved /
S } PLUMBING INSPE OR
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