691 O Z O l S c! Lor No. ' #12
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PLICATION APPLIANCE PERMIT
FEB 7 196ZC F CUPERTINO n
Date CITY
-5dPDTINfVG.._-- Permit No. 4 _
Fee S
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.
0
Use of Premises Reser
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n Owner Rousseau Org. _ Address 82 IfQlf
Marl
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SAN CBfLOS SHEET METAL WORKS, IN
G Addr nC19 CO
779 OLD C(03d6b MVAM�4DGRNr
2io�E}'lltle CALIFORNIA Appm p1ULBING INP R
Remarks Wheckii V45T
T&of Appliance I Units Fees II New Re t'C
Gas Ranges
—Gas 'Plates
Circulating
n& Heaters
I I
--6—as—Fired Boilers
Warming Ovens
Percolators
Griddles
—team Tables
• ravity Furnaces
+rSuspended Unit
'Floor Furnace
Miscellaneous
(NAME TYPE) r
II
pp iance Fees
Inspected and Approved ...... ....................................
01 F INSPECTOR
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