1261 (2)NO. �e;rT
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APPLIC'ATI'ON R APPLIANCE PERMIT
D
JUN 4 9963 C OF CUPERTINO (/
Date (T 1, OFC 19&J Permit No.
y Fee S�!z
Application is hereby made to the City of Cupertino for a permit to install
rh. gas appliances as listed on the reverse side hereof, and agrees, to install said'b. •f �'
appliances in accordance with the provisions of the Plumbing r',ode."�
'of'the City -0
of Cupertino, and al er laws applicable thereto: '
� 5/6t
Use of Premises A A IV A
7own ddress
/46
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