51167.2 (2)21871 Clumbus Avenue LOT NO. Tri
NO. STREET�tt
AP.,PL�C TION�IFOAPPLIANCE PERMIT
CITY OF CUPERTINO
'MAY 13 1968 V" _
Date 196_ Permit No. //'(� 7 �--
L1'^V rr r uPERUM Fee $/!/, 7Si
hcation'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
Code of the Citv of Cupertino, and all other laws applicable thereto.
Use of Premises Residence
owner Ditz—Crane
By Plog Sheet Mal Address 130 S. Gilman, C.
CONTRACfOR,AGENr
Phone 378-0934
State License #142642 Approved WILLIAM D. 13--NEVICH
PLUMBING INSPECTOR <, ✓
Type of Appliance I Units Fees II
Remark, Check ✓;
(
New I Replace I Relocate
Gas Ranges
Wall Heaters I
I
Gas Plates
Circulating Heaters
Blower Furnaces I / g, &0
Gas Fired Boilers
Warming Ovens I
II
Percolators
Griddles
II
Steam Tables
Gravity Furnaces I
II I
Suspended Unit
I _
Floor Furnace
I
II I
Miscellaneous
(NAME. TYPE)
R1u�s 12 la•.�II
_
0 I// I x•711
t'ae ,"Cc � la.uoll
I '
pp Nance Fees J/�,75
Inspected and Approved.................................................................
DATE INSPECTOR