258 (f
W LC-1 , /� LOT No. 132
s ,', o. 'a4f3inaer Idie%viY
APP L^ICATION ','FOR APPLIANCE PERMIT
r' l CITY OF CUPERTINO
Date 4/16/60 " 196....., Permit No.
ii'ERT(NO Fees
r9 Application is hereby made to the City of Cupertino for a permit to install
gas apph ces as listed_on the reverse side hereof, and agrees to install said
I "appliapce m,accordance with.the provisions of the Plumbing rode of the City
?of Cupeihrio;arid!all otliei,laws1:applicable thereto.
Res '
0 Use of Premises • • :
W Owner 0 '�,s ''Rou3'seau _ Addr r7 r et Sty
. -
SAN CARLBS SHEET METAt�W RKS, INC. Address
y
' 779 OLD;L, . Goli ''AC' H. AGENT n
9 23SAV1 O-Red�; 'CALIFOFNIA Appro L
PL MBIN G IN PH a
:Remarks (Check ✓)"
Type of Appliance I Units Fees.11 New Replace I Relocate
p' Gas Ranges
` Gas Plafe �II .:' I I f
CiKWHfifig HFaters.
Furnaces I I X
GasFt.'reM il6is
P.ercola_'tor I I "tl"•"_ tl`
_Griddles,
Steam Tables
Gravity Furnaces- ` I I I
Suspended:Uriit I II I —ii
Floor Furnace I I
I II I
Miscellaneous
NAME TYPE ,'I I I I
I I it I
I I II I
-
I I II I
pp lance Fees
Inspected and Approved � ....y.�...... . •. ..... .... ... ...
I P� DATE INSPECTOR