929 (2) caS01/"5-/ I / G'✓ Zl LOT NO.
�(A, PLICATI'ONTFQR APPLIANCE PERMIT
RIJ AUG 30 1962 Ciar`-..s.,'' OFCUPERTINO
Date19C..... Permit No.
t HI t \
6� Fee S
0 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 bode of the City
of Cupertino, and all other ws appli blZtheet
i
Use of Premises
owner _ Addres,-,2
B "ArNjI AM AddressCONPhone Approved 'LpeAr ,
PLUMBING INSPECTOR
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