1164 (2) l/ 1 Z� I�l �♦ LOT NO.
NO. STREET
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R APPLIANCE PERMIT
OF CUPERTINO
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�jDste f•�/ � 19G.... Permit No.
'> C11t Of r,VPERT114C Fee $'V/
Application is hereby made to the.•Eit of Cupertino for a permit to install
gas appliances as.listed bn flig�igoe*Qs Gere f,and agrees to install slid
appliances iq;a Gorda tt�%O progision�t.ptcthe"Plumbing r.ode of the City
Cupeitido,Ynd pthet.fay', applicable thereto.
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"•,.Owner T" (�.�—��-� _ •Addrei;s�S �
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Pt:one�-39 y�•'�-,.�_,; Approved - . .� � ;':t �,:.:�*.
-ti_ _ y „ . , y• ,PLUMBING INSPECTOR
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