1148 LOT NO.
NO. ST0.8 T (+
�APPL LAT OrN�F�QRAPPLIANCE PERMIT
10FEB 19 ?a,53 c rrut', OP'CUPERTINO
Date 196!.... Permit No.
CITY OF CUPERTINO` / PK
th 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 I ws applicable thereto.
Use of Premis
u
Owne Address
By�3'f(/a//. .r�'".vi� Address .
CC N�NT M
Phone 3 / Approved
• PLUMBING INSPECTOR
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