1123 LOT NO. /a
No rP� STRBET
APPLICATION CFF,OR�FAPPLIANoCE PERMIT H 17 1353
Dates 40` r t't n+r196..Z Permit No. �
Fee$
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 r'.ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises :+u
IF
. Ovine Address��
By Address
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CONTRA CTORI' GENT ' -
Phone �f��75,0' Approved
'4 PLUMBING INSPECT
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