1158 (2) cc teW�
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No. STREET
���A}}''PP_LICATON%�R APPLIANCE PERAAIT
�AR� �o�a GIM OF CUPERTINO
Date J C i7 19, 196,3. Permit No.
CITY OF CUPERTINO Fee $ G.
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.
aUse of Premises
n OwnerUkr i96 c G' ar c
Address_
ByAddress
CONTRACTOR, AGBNT
Phone—��y=f��1 3 Approve _
PLUMBING INSPEU I
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