355 LOT NO. �S
NO. LS ..RT .
L CATION ', APPLIANCE PERMIT
DEC 191960:1 F CUPERTINO
Date .Q Permit No.
Fee E /
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 of Premises / v
17i Owner(Xtrnml �l �S�s-,-�G� Address
By DIVISION A191k Address_ �
Z_'W HEATING &cS} WtA4GeV Approve
rBiLn' �T PLUMBING INSPB OR
v:
a �
0
------------- v
--- - --- ---------
3
z _
v ^o
ti ` rt n
C