69915 7995 Folkstone
CITY OF SAN JOSE BUILDING DEPARTMENT
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APPLICATION FOR GAS PERMIT
Date...-...f . Q--I 1------- 19--------.. Permit No......... / / f✓_
The undeYsign�d' Ar y� a s F t'�r7 the Plumbing Inspector of the City
of San Jose fort sayd �nces and/or gas pipes as listed on the
reverse side hereof, a d agrees to install said appliances and/or pipes in accordance
with the provisions of Article VIII pter�,� t e pn Municipa1 Code, and
other laws applicable thereto. �J4v F
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. f
OWNER ................ .JC .. "....:`'.t"'.. .....---------------------------------
ADDRESS ------------n -n - .-1 -Lc J� ti tl ?i? ....h }..'
USE OF BUILDING ...... ?. . .._................... . ..... ............ .... .. ..
FORM 280-20 4/67 10M Signed ............. M . . ..............
7995 Folkstone Z/IAr-1� V W
Type of Appliance No. Remarks (Check -/)
=Replace
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Automatic Controls
Flue and/or Vent ,
Hood and/or Duct
Clothes Dryer
Permit Feel; �
TOTAL
FEE S
Inspected and Approved By
HOUSE GAS PIPING
Number of Outlets Size of Main
FEE
Tested and Approved By