83107 7409 Fallen Leaf Lane
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
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Date......_ _� . . . ....�.�::-, ..... 1971. . Permit No......h...J........ - -
The undersigded hereby makes application to the Plumbing Inspector of the City
of San Jose for a per�rrit i I ap p gas pipes as listed on the
reverse side hereof,�andte_ � �e �d a s sand/or pipes in accordance
with the provisions of Article VIII, Chapter 4, of the San Jose Municipal Code, and
other laws applicable thereto. .�r �/f,�F 1/
I certify that in the performan e work o whit i permrt is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of Californi /J
OWNER......✓..� ....... ./��.(
.......................... ..........
ADDRESS.... g. ---- �jF/�fl, f<F2 � - x KF . LOT NO. - -..
USE OF BUILDING....../(i[s/ . .... - - .....
280.20 (Rev. Apr. 69) Signed!L`LG`_r_ '.
,7409 Fallen _Leaf LAY/� ��� ��� - °� Wea ern A 0 _
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