1242 lOT NO. 7
NO. STREET
�APPLIL CATIONFOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date
I 6
MAY _196 _
f 196.3_.. Permit No. -
UTY OF CUPERT:I'^ Fres
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as 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 ofPremises- 0'6�- "���
Address
By"l's.ccu ii Ww Address
r�J CO/N,TRACTOR, AGENT
Phone- Approved
7��.3 Approved _ IVIUI�/I
PLUMBWG I" tc R
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