1528180
LOT NO. 4C/
NOET
. R'- Ir
® APPLICAT10 OR APPLIANCE PERMIT
t Q T 14 7916 T, OF CUPERTINO
Date T 3 195:; 196..... Permit No. /� a
r, Fee S '2r
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 r -,ode of the City
of Cupertino, and all other laws applicable thereto.
Use of
t
Owner Address—
By
Address
GENr _
Approved �'LIF. PLUMBING wscacroR,-
�,Ik
0
T