78895 1043 Colony ' Hills Drive
CITY OF SAN JOSE / /0 BUILDING DEPARTMENT
`SS�e APPLICATION FOR GAS PERMIT
Date---1-z----7--------- -------------- 19-74Permit No.--.�/!. J/-. G.... --.--
The undersigned h eby makes application to the Plumbinq Inspector of the City
of San Jose for a k m' t a s p 'ces a r gas pipes as listed 'on the
reverse side hereof, s id p li e and/or pipes in accordance
with the provisions o A i VIII, C p r 4, e an Jose Municipal Code, and
other laws applicable theret .
I certify that in the performance of the whiQ�t ism�t s is e
shall not employ any person in any manne s o vio erk cm-
pensation laws Calif rnia. ' ml
OWNER... r� ............ ................. .. . .. ...... ............ ... - -
ADDRESS!- l` ------ r. .... .. . . ___..... LOT NO............. ..
USE OF BUILDING.._ - . .... .. .......... .__...._ .. .. .. . ... .._......
'y�}gyp. . .. .
280-20 (Rov. Apr. 69) Signed C��'E �/U ' .. . . ... ..
1043 Colony Hills Lane_ Selloff At1aHeatin
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