1265 LOT NO. 1/0
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APPLIANCE PERMIT
f,t*P)4PQ11C;1Ak0Nh0RJUN re 1963 WY
�] OF CUPERTINO
Date JUN 6 19ff 4 , 196..... Permit No. �"Z �S_
CITY OF CUPFRT"
Fees "—".a 5�
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.
Use of Premises
in Owner✓moo-awa�c N-%�C-a-�.-a.✓ _ Address_ _
BY Address
ACTOR, AGENT
FF9kTdhf R cucET M€TAk 60. Approved .
180 E. SUNNYOAKS AVE., CAMPBELL. CALIF PLUMBING INSPECTOR
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