1543 (2) STREET�GX-o C •I LOT NO.
POP,
No.tP I AO�11 FORA P�LIANCE PERMIT
V Ms/ 81963 �.rj Di CERT O
Date t96� Permit No. �5 _
CITY
Fee S
Application is hereby made to the City.of Cupertino for a permit to Install
y gas appliances as listed on the reverse side hereof, and agrees b to Install said appliances in accordance with the Provisions of the Plumbing rode of the City
of Cuperiino, and all other laws applicable thereto.
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Use of Premises
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AOwnei_...+.' yam. ..• , � .�:. Address_ =Z..>..: 4..
By' err it Address_
CONTRACTOR, AGBNT�l .
PLUMBING INSPECT
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