382LOT NO.
NO. MBET a
`A R APPLIANCE PERMIT
(�I1' OF CUPERTINO
C� F 1 'i77�
Date , tw'' Permit No.
CITY OF CUPERTINO Fees
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 code of the City
of Ctipertino, and all other laws applicable thereto.
+Use of Pierr ises
Address
By -
Approve,
'CONTRACTOR AGHNT '
Pfione 1 Approve ^
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