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NO. .sTaBHT 33&ywo0Terrace
SAPPLICATION FOR APPLIANCE PERMIT
S•, L• CITY'OF CUPERTINO -
Date 4/3/63 196..... Permit No. `
Fee S 1
cX 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
C 'appliances in accordance with the provisions of the Plumbing rode of the City
�l oPCupertino, and all other laws applicable thereto.
Use of Premises Re s
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OwnerC'amino Del Homes _ AddressP Box 4
SA LOS SHEET METAL WORKS, er O
7Xy Address _.
R, AGENT
SAKCARLt, Cf ol'�y Approved _
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i PLUMBING INSPECT
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