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21461 Elm Cc
NO. STREET
LOT NO. J
APPLICCATLO.0 FOR APPLIANCE PERMIT
J OF CUPERTINO
DateI,
i-
96 Permit No.
I L_u w y aw �.
Fee $,26- 6-0
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iQ pli tion�sl ,)V �I to the City of Cupertino for a permit to
in tall as ppliances I ed� n the reverse side hereof, and agrees to
install said appliances in accordance with the provisions of the Plumbing
Code of the City of Cupertino, and all other laws applicable thereto.
Use of Premises Residence
Owner D1tz2Cra e
By"7
>b ,A E
Phone.CAMPBELL,CALIF.95005
State License STATE CONTRACTOR'S
L GBISL t 14[0
Approved
PLUMBING INSPECTOR
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of Appliance I Units Fees 11 New
Ovens
Furnaces
Appliance Fees