364 (2) f Q yo I —J 4e, �� �LOT NO—
NO. T
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A Ck1FOR APPLIANCE PERMIT
�10 TY OF CUPERTINO
1r31 `�
1 a I. , 196..... Permit No.
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Fee S��
G'ITAYpI f CtL� lon '3 r o the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
of) appliances in accordance with the provisions of the Plumbing r ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises /% 'c
B
ro
in Owner. Address
By i �. Address
CONTRACTOR, RNT � 7 /
Approved
PLUMBING INSPECTOR
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