1181 O $ OI Rolfe Road Lor Pro. 16
NO.
® n h OR- APPLIANCE PERMIT
L ►'j APR 9 1963 OF CUPERnNO
pa Maroh 20th 196.S Permit No. 1191 _
CITY OF CUPERTIN Fee: ' 1.a'ii
Application is hereby made to the City of Cupertino for a permit to install
to gas appliances as listed on the reverse side hereof,and agrees to install slid
mairr
.�+ appliamca in accordance with the provisions of the Plumbing ',ode of the City
w of Cupertino, and a8 other laws applicable thereto.
UseofPcemisea Trialez' — new dwelline
S
mer Lee — Tom Interprisee _ Ad 18 7H mf ton Ave. S. J.
ROYAL SHEET METAL IN Ad 8 C Ave. S. J.
CONTRACTOR,AfleNT
Ph 378-7481 AP
FLUIrRING nes
Remarks (��_
Ty a of Ap liana Units Fees II New Replace Rebate
Gas Ranges
Heaters 0
Gas Plates
Circulating Haters I
Blower Furnaces 00 I
Gat Fired Boilers I I
Warming Ovens
Percolators
GridI�
Steam Tables
Gravity Furnace
Floorurea nit
Floor Furnace
Miscellaneous
'(NAME TYPE)
pp fiance ees
Inspected and Approved ...... ..........................
DATE. INSPECTOR