1590 (2) l�f
LOT NO. �.
APPLICATION FOR APPLIANCE PERMIT
T CITY OF CUPERTINO
Ehie ' 196.�3Permit No.—/ —I
� Fee $__//�
l� f'1 f YApilr ationis76eieby made to the City of Cupertino for a permit to install
gas appliances as fisted 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/
L
Owner _ Addresses/0
ByAddress 7 a _ _
C�ACCTOOGENT
R' Phone � G—f/ i i Approved_
v I + PLUMBING INSPECTOe
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