650161 �1 I Weetern Drive LOT No. 97
NA�P -AbM :APPLIANCE PERMIT
DEC
12 1�'iB p cUpEnrnvo
LAK 12-5-61 196.-.- Permit No 6S�
CITY GE V 1PERTINO pee a 1.50
CD 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 aaardance with the provisions of the Plumbing f'.ode of the City
of Cupertino, and all other laws applicable thereto.
aUseofpremises residence
8
Owner rarmnonWea7*L. Al Awns _ Addrm—_
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slmcnA e"'-093�� Approved - —
riuxawe nasr
of Aonliance I Units Fees
NAME
Inspected and ApproVedy('t.�..... . ................
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