1030 LOT NO.
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It APPLIANCE PERMIT
OF CUPERTINO
�L V 1962
Date 11 , 9G.: Permit No. y
to
CITY OF CUPERTINO Fre s—
Application is hereby made to the City of Cupertino for a permit to install
mbgas appliances as;listed on the reverse side hereof, and agrees to install said
,4 appliances imatcordance with the provisions of the Plumbing Code of the City
r4 of Cupertino, and-all other laws,,applicable thereto.
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SAN CARLOS Addressg- BOX
, —
T'I-ROAD Addres� O
SAN,CAR OS, GANIFKDR7da1 AGENr
Phone 9 1-260 Approve
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