566 (2) 19788 Wheaton Dr. _ LOT No. 43
No; sraeer Idlewild Greens
R APPLIANCE PERMIT✓•
jam- C QF CUPERTINO
LL f QCia 1961 :
Date 1V71i 1 196.___ Permit No.
CITY OF CUPERTINO Fee a /
Application is hereby made to the City of Cupertino for a permit to install
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.
�C
Use of Premises Rye
u
=" t�a}�w. r Rousseau Org. _ Address 82 M IU- S
•SKtJ CARLY�aS EfET' q p KS. INC. I .
8179 OLD COUNTY ROA � Address ✓til C�9 C0
AN CARLOS,c NIAGENr
c it :one — Approv
f PLUMBING INSPE
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
_\r/alll Heaters
Gas Places
Circulating Heaters
Blower Fumams�
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gra'+ity Furnaces
Suspended Unit
Floor Furnace
I
Miscellaneous
NAME TYPO I II
I III I -
I I II
pp lance Fees
Inspected and Approved,/& ._ .
DATE INSPECTOR
2 $
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