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APPL CAT,IAN FOR APPLIANCE PERMIT
CMIOF CUPERTINO
�E§EP821§64161.
Date 196..... Permit No.
OF C' ; R . _. Fee: ss ,
Application is hereby made to the City of Cupertino for a per it to to inst
gas appliances u listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of
owner_ INLAND EMPIRE DEV.
By MERCURY SHEET
CONTRACTOR, AGeNr
Phone 739.4223
960 CAMDEN AVE.
Address
Address 81 AUq AVE., MT. VIEW
Approve eAdl
PLUMBING INSPBC70R
Gas
of Appliance I Units Fees
Furnaces
NAME
Inspected and