51189 (19) AZ/3 J/
No. a
�sttreet Lot No.
® j&J !'A 'nON FOR APPLIANCE PERMIT
X47 Cily of Cupertino Q
e � Permit No.
• Fee S �7 1
``��allce r r is��oge City of Cupertino for a permit to inalall gas appliances W
o listed on he reverse etw`�,and agree to install said appliances in accordance with the
o u t�b� of the Plumbing Code of the City of Cupertino, and all other laws applicable
thereto.
Use of Premises
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Owner ' Address
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By Address
3 Contractor.hant G 2. 30-i
Fisons C
State I j se Approved PfAbinz inspector �/
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