1070 (2) LM NO.
NO. ST IIET
A PL"� AT:ION FOR APPLIANCE PERMIT
`CITY OF CUPERTINO
7 3
Daref
�=�1/y_p2 796..y Permit No. /�
Y Itt CUP II U(� Fee :--lam
CITY
is he eb"y rt5�dito 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 00a'�s /
Owne _ Address
Address
CONTRACTOE, AGENT _
Phone. 7L1.. g� Approved
i PLUMBING INSPECT R
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