1128LOT NO. O
NO J LIM"T
)APPLICATION FOR APPLIANCE PERMIT
W JAN 17 CUPERTINO
Date �(i_G 7�. � rJt 1Drrly-I I,gg6.� Permit No. .�
Z T14 .
Fee 3
Application is hereby made to the City of Cupertino for a permit to install
ygas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing f:ode of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises n .I
h Owner,Lep l W,Z)eU1°(p _ Address4,141
By�%II/f Fb�%M_Qt_ Address-
CONTRACT
ddress i�
CONTRACT R, AGENT
Phone 'ArL�(�TyJ� i Approyed
_� '� t PLUMBING INSPECT
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