473 Q
l O • LOT NO.
NO. STREET
APPLICATION FOR APPLIANCE PERMIT
� OF CUPERTINO / �7
rDate Y 1961 X96..... Permit No.�•
Fee $
Ago
((99I of Cupertino fora permit to install
gas apaslfistedtdNfhfY2vpl�e'sYde hereof,and agrees t nstall said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises��
OwnL4ML u- _ Address_
Address.
FIG;ni c res" TI"nrA� _ -
eu��•vna�c a� Approv _ /\
PLUMBING INSPECT U
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