1260 (2) NOi ART ° LOT NO.-
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� , ICNF R' APPLIANCE PERMIT
L&I JUN 4 196P*,&F
CUPERTINO
Date _ 3 Permit No.—L-1-0—
Fee f —? •96
Application is hereby made to the City of Cupertino for a permit to install
M 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, an 1 other laws applicable thereto.
Use of Premises
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Address
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•�';tt y_�;,j,, �. CONTRACTOR, ,
o5 -�."���C APProv _
/ _ •Y}•` t�•�1;., j. {. , , PLUMBING INSPR O
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