49-01241CITY5655 4 libWr Rd', C' BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date --- ...L�ce( i/-----//........... 19..& ff.. Permit No. _7...Z. -.......0./..a2 !i1..
Th undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a permit to install said appliances and/or gas pipes as listed on the
reverse side hereof, and 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 thereto.
I certify that in the performance of the work for which Jhis permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNERiS'v....hE..... -�t.V .E.N.... ..2� . ........Q...............
USEOF BUILDING-- ....... ............... ------------------------------------------------------ -
Form 280.20 IOM 4/65 Signed ..1. !h%2Z ��--........................
5825 Bollinger Rd. Sharon Welsh
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