77855 1181 Elmsford
CITY OF SAN JOSE 4l BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
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Date� ....�j.�.......... .. I9..Y�.� Permit No.....--~� -- ........
Th A'undersigned here y mak s a�,p�plica iionn lo,the� bing Inspector of the City
of San Jose for a per�t( in 1LUJ ' c� ` " gas pipes as listed on the
reverse side hereof, and agr es to install said appliances and/or pipes in accordance
with the provisions of Article VIII, C ter 4, of the San Jose Municipal Code, and
other laws applicable thereto. `flj��
I certify that in the performance he o r wh s permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws f Califfornia
OWNER �
...ry!/.�... .uyr/P± �i1/Yl• ... ....... ................ .........................
ADDRESS./.I--r��_lG.. . .. . _l S..p _......._......._.. LOT NO...--------.--
- _ - -
USE OF BUILDING-- � ............ ................ .......... - -.--- --...__.....
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280-20 (Rev. Apr. 691 Signed ---------------- -
1181 Elmsford R&R Plumbing
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