1611 -30LOT NO. Af
NO. STREET
PrP.,LICATION�iFOR APPLIANCE PERMIT
ClI Y OF CUPERTINO
F 10 1964 �1 /
Date 196.`� Permit No. All
v �{
CITY OF CUPERT" 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 Premises
Ji Owner _ Address
Addres _ 45
CONTRACTOR, AGB T
Phone u - 7/ r) Approved `
PLUMBING INSPECTOR
TI
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0
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P
I
E ITIONAL CHARGE
}CITYPERTINO
IF. 2 1196�IN- ggq!!!!'FCTOR'SOFFICF
Date .._.. .- .......... ................................ tll.-. Permit No. .......
1b11- . ..:,.,..t .:.
T� nC 'fp T n ..
To Atl9�Hea`�4n��Lf wW,11r�ating...Co.�---------- ----- -.............Bldg• 774:-
. ;....
Address . 10700 North Blaney Are. , .Greenwood Ct. .Apts:.,
........................ .._.... ._......_......._.......
R,,,,, 1.50 zpvliance fee per unit (2T Ton) for' ,.
_.... -- ._................... - ---
( .4 Units per' Building)
air Conditioners
..........::................._.
__......- ..........................._._.......
.
Amount$ 6..00...._ Signed ........ L:.:.....(....Y,l. ^.� ..Y . . .
W( 3/59-300