1409 GLOT NO.
No
APPLICATION FOR APPLIANCE PERMIT
a I AUG 927 1 6 CITY OF CCUPERTINO
1 ^—� 196-x3 Permit No. 6
Date —r /
Fee S
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
V appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
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a,
17i Owner Address y%�
B Address
C ACT R, AGENT
Phone ���3 Approved
PLUMBING INSPECTOR
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