72213 1077 Gilway � " Y/
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMMIIT(^� /
Date......._MAY----2.9-_1.965.....-----
19--- ../.- .11-- 1.._-- Permit No... .3...-------
The undersigned her y a pi ti t umbing Inspector of the City
of San Jose fora er ' I 6c'€4.arTd/or gas pipes as listed on the
reverse side hereof, and agr s to install said appliances and/or pipes in accordance
with the provisions of Article VIII, Chapr , of the San Jose Municipal Code, and
other laws applicable thereto. ( orp �(
I certify that in the performance of t e wor for w t s 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 . i�lf �C -_l `'e*i� ......
......
ADDRESS .�.6..�� '- ------- ... . ... ... .... ...............
USEOF BUILDING ----- .... . . .. .... .... ..................................
FORM 280-20 4/67 IOM Signed ._..-MERCURY SHEET METAL & HEATING, Vta
1697 Galway Mercury
Type of Appliance No. Remarks (Checc ,/)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heafers
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit /
Floor Furnace
Automatic Controls
Flue and/or Vent i D
Hood and/or Duct
Clothes Dryer
Permit Fee i
TOTAL 7�
FEE 7
Inspected and Approve410-4
HOUSE GAS PIPING
Number of Outletsl I Size of Main
FEE
Tested and Approved By