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
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`7 Owne, J a t/ _ Addr _
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CONTRACTOR, AGE
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Phone��[ _�__7/ _ Approved
2" PLUMBING INSPECT
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' 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
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In6 3/59-300
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