77183 7540 Bollin§er Road
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT /
Date... 19-7C/ Permit No.. �.7{..: .... .....
2a
The undersigned h eb ay,�Q a li io fh PI bing Inspector of the City
of San Jose for a pAzM, a n3 n 7c.afi as pipes as listed on the
reverse side hereof, and agr s to ins al sad pplianc d/or pipes in accordance
with the provisions of Article VIII, Chapter 4, of the San Jose Municipal Code, and
other laws applicable thereto h l �-J /�P
certify that in the perf r of r r t ermit is issued I
shall not employ any person in m n s e e workmen's com-
pensation lawsC�� -
aalJlifornia.
�CGC Cif� p //
OWNER... .. -- -- -- ------------- ..--------- ----..----------
ADDRESS_/-�� -- .. .d(!GG'. r ...... .... .... LOT NO..
J ..��
USE OF BUILDING..
N/' ------ - -
280-20 (Rev. Apr. 69) Signed- _, r �.'..d�(�"'::`'�-.. ...-_ .
7540 Bollinber Road / Belloff, Atlas
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