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APPMCATAON
NO., sieeei FOR APPLIANCE PERMIT
® OF CUPERTINO
Dat tUft"
960... Permit No -59 /—/j—
Fee
Fee S ZDV
r/+'�T�' � lEt�3d&�(�, City �
tr!►p Hca ' is e G of Cupertino for permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises %6.z -
Ji Owner _
os Sheet Metai Wo
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Address
Addressi�l rGr. •
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of Appliance I units Fees
Gas "states
Miscellaneous I i�
(NAME TYPE) I II
pp lance i ees D
Inspected and Approved .� alp l ...................................:....
p Tp INSPECT00.
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