1286 LOT NO.
NO. STRBB
�Lr ACTIO ¢QR APPLIANCE PERMIT
CITY OF CUP.ERTINO
n� /JUN 24 196?
Date 6 — 196..—.x. Permit No.
l� C"I-Y OF C� s"EY.-
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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
�y appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises l if o A
V) OwneQ-� .r. ,�.Gr/ Address— i _
Addressi L e�-z �JiI�U
77 ,� CONTRACTOR, A i2 O
PhoneL✓_�— y3S� Approved Yk
PLUMBING INSPBCTOR
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