79053 . 7921 BelkriapDrive
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date..........................................�` .... 19_ .�. Permit No--------7ye)�13
The undersig r s Ica F t6 her 'Igas
Inspector of the City
of San Josef s I' �9fyf as es as listed on the
reverse side hereof, a agrees to install said appliances and/or pipes in accordance
with the provisions of Article VIII, Chapter 4, of the San Jose Municipal Code, and
other laws applicable hereto.
I certify that in t o rmancee e r mit is issued 1
shall not employ a rs in anyAn n r s lol orkmen's com-
pensation laws of ali rnia.
OWNER......._ .L.L..TCN-!;.A.a-....N''—L`----------------------------------- ------
ADDRESS
----ADDRESS ...........7-- nZ--C..... LI.T.wR P..... j� .............................
USEOF BUILDING ./ tea................_......................................... ....�.
Form 18070 IOM 4/64 Signed _... !. ....RI--- ... ......-----
7921 Belnan T),iN,P ..tAfe,�, Plumbinq
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