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L � APPLIANCE PERMIT
AUG
C CUPERTINO
3� 196i
Date 196..... Permit No.
��TV " CUPERTINO Fee $ n Z;57
App cat on 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 bode of the City
of Cupertino, and allotr laws appl'cI a thereto.
Use of PremiseF
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17i OwnerT
BY— �� �—
/ CONTRACTOR, AGENT —
Pl;oae Approve
I .PLUMBING INSPECTOR
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