762 (2) V / I /Z"� LOT NO. r ZA—
No. STREET
APPLICATION FOR APPLIANCE PERMIT
G I g OF CUPERTINO
DatTy
131996"_
96 6--.-. Permit No. 76_ ao
Z. - @:.. ., Fee S-
' hQ', h }� �t � City of�Cupertino fora`permit to install
gas RpJ Tees a'§'liste on the reverse side hereof, and agrees to install,said
appliances in accordance with the provisions of the Plumbing r'.ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises_ `
-ROTH 5HEzi' METAL, INC,-- '-
C,
Owner ,Address"''. ^ '+r' r' •` 1 �'
E;
M1 „ CO TRACTOR, AGENT- jQ'f t
"'Pi,nne�,/ . '1p� Q_D •. Approve r
";j':i ' 1•-'si-«-- PLUMBING INSPECTOR- - t
01
v R
0
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