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AP.PLICATION FO I APPLIANCE PERMIT
- CITY OF CUPERTINO
Date- �'/n ±`.�.->�1 96..C� Permit No.
N 0-0
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Application is hereby madeto the City of Cupertino for a permit to install "-
Q + •gas appliances as listed on the reverse side hereof, and agrees to install said ,�'
�`. appliances in accordance with the provisions of the Plumbing ":ode of the.Cij,:'
of.Cupeitino, and all other laws applicable thereto.
Use of Premises
i Oivne ?2� Address
Bit 4-h ed /if�7/'
CONTRACTOR AGENT
Phone �'S � t Approved f�C/
IPLUITNG INSPBGTOR
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"NOTICE CE
*BUILDING INSP, 'S OFFICE
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CITY or
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hereby auth66z6d;f62onn the' service- for
Owner or Tenant,'-__ . P-2
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110 6/59-500