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PS It'AT ON WO .. APPLIANCE PERMIT
Ca
F CUPERTINO
11 9963
Date 3 —,F-" 196.3 Permit No. 1'1—
CITY OF CUPERTINO
Fee
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 Premises ,s..�✓� �
JS OwnerJ Address 4;
BAddres
CONTRACTOR,
Phone�„��y3�j Approved
PLUMBING INSPRGY
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