274 /O � I 1 �t lJ"W.� ✓ 1 11 V'� LOT NO. LO
NO. ldlewild
U 1� OR APPLIANCE PERMIT
SEP 30 9960 OF CUPERTINO
Do Dat 111 196..... Permit No.
Fee $
Application is hereby made to the City of Cupertino for a permit to install
Q gas appliances as listed on the reverse side hereof, and agrees to install 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 .
n Owner Rousseau c�rg. Address 82aiet S S,F,
--+�$AN CAw$SHEET METALL WORK IP16 Tr} AddressONTj TOH. AGENTZ ej GOLo COu�V i Y I{CJAU -APPro a or$ {E 1. PE
z: , 17
r '
em—arks (Chedc 7)
TypStf ApplaRIqh.. nits feeP11Uew Replace I Re O
rate
Gas.
VWX�;VWUW2
v Wall��aters -j
Gas Plates
Circulating Heaters
Blower Furnaces
Gas�Fred Boil
Warming Ovens
—Fencnlators�11
Griddles I I
Steam—Tablesl I
Gravity Furnaces'
Suspended—UnitII
—
Floor Furnace
Miscellaneous ii fi/
(NAME r(PE)
pp tante Fees
Inspected and App ......
INSPECTOR