1215 (2) /Q BBT ` LOT NO.� -
APPUCAT� FOR APPLIAkCE
CITY OF CUPERTINO PERMIT
Date 1963 Permit No. 12/6
Fee E_6P • 's
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 C rC foCt
y '!ne
er� '— i Address
Address' Qee--7 �{p!
NTRACTOR, AG APj
7 �y�T Approve
PLUMBING INSPECTOR
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