1531 (2) C7CM a S
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LOT NO.
1 NO. i7.1,
Q r KEP �jkFOR APPLIANCE PERMIT
/ q fitq LU CITY OF CUPERTINO
CCT 2
Date l0 l'G d03 196..... Permit No.
CITY OF CUP Fee :
Q� Application is hereby made to the City of Cupertino fora,permit to install
4J gas appliances as listed 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 atl,other laws applicable thereto.
P. {
Use of Premises -
A Owners e, . � '" _ Address
By CONTRACT GENAddress
T t
:Approved •_
I )r 'PLUMBING INSPB ,V
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