486 (2) l V a LOT Nn.-5�5
NO. ` U
L AT N APPLIANCE PERMIT
I APR 1961C , CUPERTINO
Date �f,R ..... Permit No. � -_
L' IT Fee $ 1'3z
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 accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of PremisesA x A�Lr
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nOwner .iu' t a,� ALS u- Address
��«ISI�N Address L '
y HEATING &c3%P�?cIT�g2 7 Appro d
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- PLVNBING INSPBCT
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