1612 Le /'O LOT NO.
No InE T
UTIONI AAI APPLIANCE
A oCE PERAIY
JNoFcuPRT
Datec!TO --PA � , 196..`r` Permit No. /e//:;:2—
Fee
7""'Fee $"? t --L)
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
r7i owns 1 _� Addres
B)e- _ /o,TRAddresss� —
CONTRACTOR, AG
n Phone v Approved
f/ PLUMBING INSPECTOR
�L mw C) y � b � � mnn' ��n
rt
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0
n
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of
ITIONAL CHARGE
® �APR 2 19 L�`7[/}T) NERTiNO
ROf1.D INCTOR'S OFFICE
Date . 4- n 9 64 Permit No. - 1612 ..
CITY ...OF.... PERTH Ys' Bldg. B-8
To Atlas._Heating--.&---Ventilating...C-o.. -................. ............
Address .1.0700--N.-__Blaney-Ava.,--Greenwood._Ct..-Apts.- ....
Reason $1'.50..Appliance..fee_.per.- 21...Ton..Air-...Cond.itioner,
4-Units-._per..Building...... ---
......-_......... ..
a Amount 3 .6'.go Signed
i06 3/59-300