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1614 LOT NO. NO. STREET rFP LICA ION PR APPLIANCE PERMIT 1JAN n 0 1964 Ic,gryY OF CUPERTINO Date�C ./ / S� �=',, 196. Permit No.� CIT OF CUPERT' �U � Fee 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 Code of the City of Cupertino, and all other,,haws/applicable thereto. Use of Premises u ' `7 Owne, J a t/ _ Addr _ gy�i�;�� /l� T ' Addres g CONTRACTOR, AGE q, Phone��[ _�__7/ _ Approved 2" PLUMBING INSPECT n 0 ^ — E � m A _---_— -- O . J ' Ulu DITIONAL CHARGE CI CUPERTINO fff,APR 2 1W.DI ' �SPECI Oas OFFICE Date ....._.. .......4-2......... ............. .... 19...64 Permit No. 1614........_..._...__.. �11TY F QUg W_ "� Bldg. B-10 To . .A as... at ng._n:... eatilating..8.o...__............._._........_............. Address .. 107OGN- Blaney Ave, ,...Greenwood...Ct, Apts. ...... Reason $1...5O..Appllance....fee.. per---2j- Ton_Air...Gondi.tioner ............. ............. ......... ...._.__......_........ Amount S � , g ........ -. ............... U !✓2, .. iJ' In6 3/59-300 4