1454 // \J v !✓ I�i:ti".��/r0 LOT NO.-
NO.
O.NO. STREET - Fq Baywod Terr.
Tr. #31550
APPLICATIO F/OR APPLIANCE PERW
CITY OF CUPERTINO
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N [/
Go Date_ 9/6 196.3 Permit No. SJ
0 —
'� Fee $ r SC
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 instill 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 Res .
r7, Owner Camino Del HoTnALR, _ AddressF,0 Box 634
By pp{{ Address Cu t1IIo
''t.. 71i^ 0 1 d )f{ Hp AGENT
,Phogeh Approved INSPECTR
PLUMBING INSPECTOR
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