1105 _. I ld' O •1/�KIV LOT NO. ...:71
NO. �pSr�TIBET i �R - 7 r"t 43fte
APPLICATION FORT APPLIANCE. PERMIT
�? jAP� .� ;�Cd�CI `OF.CUPERTINO
Date�:`•s. � /6 -- -- A.{�� i�,,(96..... Permit No.- j �
Application is hereby made to the City of Cupertino for a permit.to.install
gas a!iplidnces as listed on the reverse side hereof. and agrees to install'said
appliiAi in accordance with the provisions of the Plumbing r:odevbfltYk City
of.eil, o, and.all other laws applicable thereto.
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Use of,Premises
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Owner Addr .
SAN CARLOS;Sk( - �, � —
77AY_ / AddressElk
SAN CPhone' - I Approve
I PLUMBING INSP
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