1130 NO. STaBBT+, C
APPL'ICA►TIONLdP
' R APPLIANCE PERMIT
11cfAN 1 7 1068 OF CUPERTINO
Datil 196..... Permit No. 1130,_
Q- Fee S
I,. 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 bode of the City
s, of Cupertino, and all other laws applicable thereto.
Use of Premises
Ownger Address
�;
r
'ry CONTRACTOR,
ENT-
tPL.' BING
' ''aPhone fr2S'O I 'lApproved INSPB
H a
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