439�j 1 .
C�.7C `ice. Q. -tom- Lor No.
,NO.- 5 6T /
APPLICA ION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
_ a9
Date 196..... Permit No. t4
Fee $
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
\y of Cupertino, and all o1her laws applicable thereto.
2 �
+ Use of r ises
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LX Owne Address
By Address
CON CT 0 , AGE N
41r1i Phone Approved
PL ING I _TOR
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