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100139 (2) LOT NO. NO. STREET „ < APPLICATION FOR APPLIANCE PERMIT a z ® s®� CITY Y OF CUPERTiNO M �Yo RLL 0 Date 9fi— Permit No. /J 3 8 - 1969 Fee•$ W LL 10 Application is hereby nlR-de to the City-of Cupertino for a permit to o < CkpT syallQF ��fled on the reverse side hereof, and agrees to Z N install said ap a s iWordance with the provisions of the Plumbing W Code of the Citv of Cupertino, and all other laws applicable thereto. W IW Use of Premises 00 �p M 0 Own � -4 ddress//,i–S)D �/12G� L(ilie.e./'iev z JZ By Address J•O CO AACTOR, AGE !T Phones ; < -�. – m _ —�; Y Z ' Yh W o s State Licens Approve U PLUMBING INSPECTOR V � � � T � woac� mnc� ac� n �+ m m w m 7 V z 3 bg n w � o