69915 7985 F619stbad
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date.._ ---------------------------- 19_ .7 Permit No... ./..../e
The undersigned hereb makes �gpl'�atio t t � mbing Inspector of the City
of San Jose for a perp tf's pli s d/or gas pipes.as listed on the
reverse side hereof, an agr es to instal said appliances and/or pipes irLaccordance
with the provisions of Article VIII, Chapier _the Sp� i Vn�I de, and
other laws applicable thereto.
I certify that in the performance of the work for which this permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER ------------ . _1 ... - (( f................
ADDRESS --- - ------ `.- .....................
USEOF BUILDING ........L13..'.................._....---------- ------------- ....................
FORM 280-20 4/67 10M Signed -------- . ' SZk'i'`D
7985 Folkstone /,/Ply /,/meq West Htg
Type of Appliance No. Remarks (C eck V)
UNewRelplace ;Relocafe
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Sfeam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Automatic Controls
Flue and/or Vent ,
Hood and/or Duct
Clothes Dryer
Permit Fee - —
TOTAL
FEE
Inspected and Approved//�`'f A 7 By
HOUSE GAS PIPING
Number of Outlets Size of Main
FEE
Tested and Approved By