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1025 ' .I l,`.( _.JC1L.`ts'1:: •�CJY LOT NO. Yl3
No. STREET
ra©t x315
APP`LICATION :FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date 1WI62 196..... Permit No.
Fee $�
Applicatiog is hereby made to'the City of Cupertino for a permit to install
Cgas appliances as listed on the reverse side hereof, and agrees to install said
!' appliances in accordance with the provisions of therPlumbing rode of the City
of Cupertino, and all other laws applicable thereto. '
a`Y Use of Premises S:or,,�
.":Owner E Addres§MPLUMBING
SAN �ARIOS SHEET MET— L WVKKS-ha
770 AddresARLOS AGP.NT SAIPhoneApprove
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