1769 • RB ` ' ✓ LOT NO.'
APPLICA �j
MAY 21 1�b4 "' R APPLIANCE PERMIT
I.'- OF CUPERTINO
\ DatenlL�_ /SC's Cl)� , 196..... Permit No.
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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 rode of the City
of Cupertino, and all other laws applicable thereto.
7 Use of Premises poA
�°n Address _
By vV�XA Address
CONTRACTOR, AGENT
PhoneApproved
PLUMBING INSPECTOR
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