51167.2 (3)N�
21851 Columbus Avenue LOT NO. #4
NO. STREET
APPLI �ATIQ�FCR� APPLIANCE PERMIT
CTT bF CUPERTINO
17 NAY 13 1968 "'!
Date n 196�5 //6 7 J�
— Permit No.
PITY OF �!Ur)FRTIf" Fee $//9.2,5
Application isliereb}' made fo 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
Code of the City of Cupertino, and all other laws applicable thereto.
Use of Premises Residence
Owner Ditz-Crane
Plog Sheet Mtal Address 130 S. Gilman, C
CONTRACTOR,AGENT
Phon 8-C 4
State License_? 1ioF/�? A
WILLIAM D. BENEVICH
X
PLUMBING INSPECTOR
v
Type of Appliance I Units Fees I
Remarks (Check ✓)
New I Replace I Relocate
Gas Ranges I
II I I
Wall Heaters I
I I I
Gas Plates I
II I I
Circulating Heaters
Blower Furnaces / I x•0.011
I I
Gas Fired Boilers I
II 1
Warming (hens I
II I
Percolators 1
I I
Griddles I 1
1 1
Steam Tables
Gravity Furnaces I
II I 1
Suspended Unit
Floor Furnace I
I
I I
II I
Miscellaneous
(NAME. TYPE)
�t��s 12 12.o-011
I
I �s11
I I
II I
_ PC
pK Fees—r�
Inspected and Approved ............ ..... .................................. .............
DATE. INSPECTOR