299 11)AL1 \VC'QtAJip( aj, LOTNO.#155
No. eeT� Idlewi ld Greens
C b APPLIANCE PERMIT
�NOV 7 1960C
OF CUPERTINO G�
Date I I /; /A ) 196..._. Permit No.._� g/
CITY OF CUPERTINO Pees_ �2
Application is hereby made to the City of Cupertino for a permit to install
p gas appliances as listed on the reverse side hereof, and agrees to instill slid
appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
(I Isr Owner Rousseau Org. _ Address
WORKS,EIAi INC R
Address r C 800 SAN�A RE7RD AGENT j9 OLD COlfh�a
Qvo�rkRt9S-C A rove
n•' ¢no�.11A Pp -PLUMBING INSPBRO
Remarks (Check J)
Type of Appliance f Units Fees II New Replace I Relocate
Gas Ranges i II I I
W al'a Heaters
Gas"%lates I I II I
Circulating Heaters
Blower Furnaces I I I X
Gas...Fired Boilers
Warming Ovens
Percolators
Gri &les I I
Steam Tables I
Gravit���F��urnaces
$uspeen eed' nJ,t I II I
Floor Furnace
I II I
Miscellaneous I I
NAME TYPE) I
I I II_ I
I I II I
I I II I
I I II I
I I it i i
pp lance Fees I 1 �- *
inspected and Approved �- .4's . ..... .... . .......17 DATEPECTOR
1