69915 7967 Folkstone
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION /_FyOR GAS PERMIT C�
Date------- -I--T..�........---._...---- 19--�[].-/ Permit No.--.(�.. ./.../` -------
The undersigned her y m a is t Plumbing Inspector of the City
of San Jose for a per �ust at ' c`eS and/or gas pipes as listed on the
reverse side hereof, and agrees to install said appliances and/or pipes in accordance
with the provisions of Article VIII, Cf r-4, of fh, n J s Municipal Code, and
other laws applicable thereto.
I certify that in the performance o he work for whichthis permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California. 1
OWNER - -1 .........................................................
ADDRESS .................. � �- p--- -� - _ . .......
....................
USE OF BUILDING .................P�Ze..5. c--------- ------..............................
FORM 280-20 4/67 10M Signed ---.....------- ..... ----- -... ..................
7967 Folkstone ll11 1774 Wes
Type of Appliance No. Remarks (Check V)
MNewReplace RelocateGas Ranges
Wall HeatersGas Plates
CirculatingHeaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended .Unit
Floor Furnace
Automatic Controls
Flue and/or Vent Q,
Hood and/or Duct
Clothes Dryer
Permit Fee
TOTAL
FEE si J
Inspected and Approved S a/r&-p By
HOUSE GAS PIPING
Number of Ouflefsl Size of Main `
FEE
Tested and Approved By