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- 1 7 IIAGZ'.�WO .� LOT NO.
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_! APLPr A;A• ,TIONFOR APPLIANCE PERMIT
CITY OF CUPERTINO
r" r 1 ,y 1 IF 6L:
Date• 196..... Permit No. '7� _
Fee S
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 rode of the City
of Cupertino, and all other laws applicable thereto.
Use of
RESIDENCE
B6O CAMDEN AVE.
Owner INLAND EMPIRE DEV. _ Address CAMPBELL. CALIF. _
By MERCURY SHEET METAL Address 81 AM A ML VIEW
CONTRACTOR, AG T
Phone 739.4223 Approved
PLUMBING INSPECTOR
of Appliance I Units Fees
fGas
Inspected and Approved