51128 20710 I Scofield Drive
CITYLOT NO.
UFM71-4-b--Va . STREET �
„ <HU u 17 APPLICATION FOR APPLIANCE PERMIT
d i D CITY OF CUPERTINO
Im
3 j Date 19. _ Permit No.
U
Fee $ 7
' 0 Application is hereby mwde to the City-of Cupertino for a permit to
o install gas appliances as listed on the reverse side hereof, and agrees to
<m 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 RPsai deneP
00
5 ; Owner George H. Hersman Address 20710 Scofield Dr,
Z ByValley Heating & Cooling Address 638 No, 13th St, San
3 0 294-��292 AGENTose
- „ Phone
ww 258540
ax State License-- Approved
_U PLUMBING INSPECTOR
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