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PLICATION' FOR APPLIANCE PERMIT
I JUN 24 196 CITY'•OP CUPERTINO
Date „ — /.__�_..� t9Ca...� Permit
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Fee $77 S 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 c'.ode of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises
Owne Psi Address _
BBP.c��� � _� Address
F6NrancroR, n
Phone ��J9— y- -3 Approved .V-A_-LL KL-
P UMBING INSPECTOR
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