297 (2) � { , , ✓� , Lor No. dNO. MEET
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CATION FOR APPLIANCE PERMIT
j4C1TY OF CUPERTINO
dDate +1/360 .196..... Permit No •=�
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 slid
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises Res
a Owner - Rousseau Org. Address
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SAN CAR i Ad r 919 Co
l°,fFu.r OLD COUn 0, "GENT APP
�..�w� . ... �. . PLUMBING INSPECTOR
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