811 (2) �..T�C' LOT NO./13 _
NO. STREET
APP ` T F��PLIANCE PERMIT
M CITF CItYERTINO
A 11 1962
Date Ct-:, 196..... Permit No.— ��_
CITY JLF CUPERTINO Fees i2-2- p
C ' Application,is hereby made to the City of Cupertino for a permit to install
gas appliances, asaisted on the reverse side hereof, and agrees to ip;tall said,},,. .�,; .r
app.Iances�'iiyacordance with the provisions of the Plumbing !ode of fke
of Cupertino,II d all other laws applicable thereto.
8 UseofPfemtses+`APARTMENT
4411P RAFALOW, INC.
`r05N Owne _ Address_ 4--t-
Ay Z � Address— 0 Cri tl Lane
; ;
CONTRACTOR, AGENT
r•Ei��P ��=S� 0_,
APProved — - —
„':.F�• PLUNE NG INSPE R
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