78886 883 East Estates Drive
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PER/MIT
Date. _12 -
/ ' ( 1976 Permit No..-.10�.
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The undersigned h Ploy�espon�t th���u bing Inspector of the City
of San Jose fora er 1.3fidei bnd/or gas pipes as listed on the
reverse side hereo an idrappliances and/or pipes in accordance
with the provisions le Ar i et VIII, Chatn� ,_, f the os M ici,pal Code, and
other laws applicable thereto: �/ � p �(�%
I certify that in the performance of t e wor which th's er it is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws Califor/n/ia.
OWNER------
ADDRESS
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ADDRESS........ 0 _� .��... — ......_ LOT NO---------------
USEOF BUILDING- _ .. ......_... ..........................._.......... ..........
260.201Rev. Apr. 691 Signed. .. - --- -- --Gu4fG�-/��`- - -- -- '
883 East Estates Drivp Selloff_ . Atlza
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