13130 3034 Colon)* '. Way
CITY OF SAN JOSE BUILDING DEPARTMENT
i APPLICATION FOR GAS PERMIT
Date-----...-la--- ---- ----------------------- Al Permit No.... ���...............
The undersigned he me p - a - it + e�P{umbing Inspector of the City
of San Jose for a pe i i s ap li es d or gas,pipes-as listed on the
reverse side hereof, an ag to in a s i p es and/or pipes'in accordance
with the provisions of Article III, Chapter 4, f the San Joe Munici al C e, and
other laws applicable thereto. � �` i l
I certify that in the performance of the J k r i e is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws ifornia.
OWNER O.L - .. .aR1. ... . ................
'&Lr
ADDRESS °OQ.. Q.. - -Q-------_. . f\L^ACX.._.. t.
USE OF BUILDING S.........v--' - ... ...--\4�1 `•..... "v
FORM 280-20 4/67 10M Signed . ... . ..a C.L.
3034 Colonial Way PJ
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