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6 GV L LOT NO. Zfze c ar ! ! 1
NO. �(^STRRET
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PPLIC'ATIONFOR APPLIANCE PERMIT
/ AN ? 1964 Q*OF CUPERTINO
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Date 4Z196-- Permit No. A
CITY W CIJPERT""' Fees 9
Q� 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.
aUse of Premises
u
r7 Owner
BY -�/ — Address -
CONTRACTOR, AGP.
Q Phone v Approve
PLUMBING INSPECTOR
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ITIONAL CHARGE
`41T f-UPERT'IN0
APR 2
PECTOR'S OFFTCF,
064),111
Date ........k-kl. ...................... 10A.- Permit No, ..........160.9_.............
To
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Address .. .......b...lamejAve.* ) cctvcW CM g.l
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Reason 4X1 .50 avDilmee r� r' y�7 uru ('a,� 'ro�l) vor
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4 jftjtt3 YeasNild$Al&)
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Amount .... Signed
I Or 3/59-300