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LOT NO, x
NGL9CATPPLIANCE PERMIT
IRMAR 11 196 I CUPERTINO
Date -3 — 196.ra Permit No. 11
Uly UF UPERTINO � Pee S a��
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 slid
V appliances in accordance with the provisions of the Plumbirle bode of the City .
of Cupertino, and all other laws applicable thereto.
Use of Premises
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r7i Owner� _��R.1n� Cod Address 65er-
By�,� Address
ONTR.1q'OR. A
Pl:one_79— y3 Approved ,
I _PLUMBING INSP8CT00.
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