1767 146
LOT NO.
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NO. "VMT OR APPLIANCE PERMIT
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+b►MAY 2 01964 OF CUPERTINO
3 a Date �"/ 196Y Permit No. /7Z7
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CITY OF CUPERTINO Fee.$1/ o v
o Application is hereby made to the Cite of Cupertino for a permit to
'o Finstall gas appliances as listed on the reverse side hereof, and agrees to
<N install said appliances in accordance with the provisions of the Plumbing
W i Code of the City of Cupertino, and all other laws applicable thereto.
J LL Use of Premises
20
O < Owner Cteelf Address
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� B,v,S` /, o r.J/� 96 44ddress�Z�EI So zO -i 411
0 CONTRACTOR-, AGENT
a Phone
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01 - —State License Approved
U PLUMBING INSPECTOR
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