51189 (2) L —jitimd,.La i d2ea e
No. Street or .01 No.,�`
A APPLICATION FOR APPLIANCE PERMIT
® ` City of Cupertino
196 Permit No.
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Q Fee S ►�
Application is hemby made to the City of Cupertino for a permit to install pe appliances as
Ow,,,/��, '�1and agrees to install sold appliances in accordance with the
`0 8 Owislo of dgrCHde of the City of Cupertino, and all other laws applicabb
ate ' the cto.
Use Of Promises /•O /
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z Owner " Address
ga gy Address
Contractor,Agent
Phone 11
L State License 4i 14"95 C OI&G Approved
1tC( P bing Inspector X
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