1163 V'V I irT' rC(� LOT NO. �✓
- NO. o� V
OR APPLIANCE PERMIT
MARgAF CUPERTINO
r Date3_dp� 196... Permit No.
v m0 "1 0
n� Fee $ 7
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 slid
appliances in accordance with the provisions of the Plumbing rode of the City'
of Cupertino, and all other laws applicable thereto.-
Use of Premises
' Osvner -
- ' _ Address — --
Address
CONTRACTOR, AGENT
Phone �y—�33j Approve 1j
. i PLUMBING INSPECTOR
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