1026'LOT NO.
NO, STREET Tract #3150
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date '711.471162 196..... Permit No./ 0 -2" C,
Fee i -7 7,4
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 bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises Res,
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Owner Camino Del Home Addres(Pon Boy
SAN CARD N OR, AGENT SHEET METAL WORKS, INC. AddresS'"p rt O
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SAlk CLiIFjC�R�IlA Approved
PLUMBING INSPECT
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��. GAS. SER1j�� ` OTICE COPY
' BUILDING I 'S OFFICE'
rCiTY O 01513TING "-'.'_�t ,
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You are hereby a d to cg8iect the G
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Owner',or Tenant
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�.+ . :'..;'a.•. "`"' 1 N'eiv Service ...
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f Reconnect
'• "' • f ode Service 4 .
Nor of A'dd.•Meters ..... : Move Meter- ...
PLUMBING> INSPECTORti"r'•
.110 7/61-500 - ..t k „Kr-"••-�,w, :q