1051 Pppp �
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NO. STREET
=11CATFQN ICOR APPLIANCE PERMIT
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CI�[xg�,yOF CUPERTINO
Date 962962 Lc:•
196..... Permit No.
CITY OF CUPERTINO Fee $
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 bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises ✓r�� �'
Owner Stn e o ���r. _ Address=
By DIVISION Address_
HEATING & SHEE1k:L*&Tll,k", AGENT
180 E. y21it)ij'MKS AVE! CAMPBELL. CALIF. Approvtd_
PLUMBING INSP- 0
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