76471 7589 Heath erwoodgxsiroe g
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date // . 19. 7c� Permit No...7�5� ---
The unde ligl�
ed hereby makes ap lication to"ce
Inspector of the City
of San Jose fora permit o s an pipes as listed on the
reverse side hereof, an in sa or pipes in accordance
with the provisions of Article V I, Chapter 4, of the San Jose Municipal Code, and
other laws applicable thereto.
I certify that in the performance o{�y �e k fo � i+Wlssued I
shall not employ any person in any m ne o as to volae Bee (men s com-
pensation laws
/lof Calfornia.
OWNER
I ------------
ADDRESS{--.?1Q ._Aea44 ......be.
... LOT NO..... ........
USE OF BUILDING-ArA( /dm ._�—s . . -C- --�..........
r..-.-..............-�-
280-20 (Rev. Apr. 69I Signed ......_........ ... ....._.........
7589 Heatherwooiv .
D. Graubard
Type of Appliance No. Remarks Check
New Replace .Relocate
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 Fee '
j TOTAL
FEE
Inspected and Approved By
jHOUSE GAS PIPING
Number of Outlets Size of Main I A'
FEE
Tested and Approved By