74296 7553 Dumas Drive
CITY OF SAN JOSE 9 BUILDING DEPARTMENT
? APPLICATION FOR GAS PERMIITy�q
Date..✓.�../YRR.....---- -------------- 190.. Permit No.........tli"!✓.. -------"---
The undersigned e y makes ppli ti ��66e '}bing Inspector of the City
of San Jose fora er r a J1� Ad1'or gas pipes as listed on the
reverse side here and es insta said appliances and/or pipes in accordance
with the provisions of title VIII, Cha ter 4, 'of the San Joe Municipal Code, and
other laws applicable thereto. if2� � �$,
I certify that in the perfor f the w r or which ism er it is' issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.� /
OWNER .�cC"v�.fl2.0........./L/.----1 .�.K.�C..f6 Ail ¢Q ----11--....------
ADDRESS ..7s~S vv o�s/5... ._JCS- ------------- -•..---+ �---------
USE OF BUILDING .. F/s//J.:..:... ...y ..._/A. ' .'o..............._............... ..
FORM 280-20 14/67 IOM Signed ..... '�`�it! < " '-'!1^"""'�'"'.... . ..q
7553 Dumas Drive �Kegaard
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