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N��STREET
APPLICATION ``FOR APPLIANCE PERMIT
GITY�OF CUPERTINO
'A4%31/63t�53
Date Permit t No.
Fee
00 i N Application is hereby made to the City of Cupertino for a permit to install
GO gas appliances as listed on the reverse side hereof, and agrees to install said
o appliances in accordance with the provisions of the Plumbing rode of the City
r-i of Cupertino, and all other laws applicable thereto.
Use of Premises_ Res .
u
Owngpmino D31 Homes _ Addres P Box 34
CARLOS SHEET METAL WOR er
Address _
�! AN CARLOS,dekLTM�AscaNr 14'
Phone— , µ Approve a_
PLUMBING INSPBC OR
1- 17
23 -ii�
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