1591 (2) 9
LOT No.
1 ' :APPLICATIONI�FOR APPLIANCE PERMIT
ef� EC 18 1963 L� ITY OF CUPERTINO
Date /
VCfr1LnT __ 196.3_ Permit No.
II 1
Fee f_ Z/P7f
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 code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
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a
r7 Owner 1 ,� ,o — AddressS/0W
ByAddress7 L—
CONTRACTO AGP.NT /�J _
p� Phone 6 — q qo-a Approved t
Y I PLUMBING rNSPBCTOLL
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