77120 6721 John Drive
CITY OF SAN JOSE 1 BUILDING DEPARTMENT
,J APPLICATION FOR GAS PERMIT
Date...`f'--1-/d. ----------- ------- 19 70 Permit No----..�/.....................
The undersigned here makes ap licat n t the�P�Iyj��g Inspector of the City
of San Jose for a per it li c �� as pipes as listed on the
reverse side hereof, agr s to st II sae app ianc s an,
pipes in accordance
otherthe provisions le there VIII, Ch yof the San ose Myn al Code, and
other laws applicable thereto. ttt999...�EEEi ��/jI' ('/j�/41}{G'
I certify that in the performance wo for w i i permit is issued I
shall not employgy person in any manner so as to violate the workmen's com-
pensation la�wssoo ,California.
OWNER...I ./c h /— /�.-- -/ ..`7. GL S__.._..................----...----
ADDRESS._.1o/..Z.2.�...0 ..��`/.5/.. �J.--- .r LOT NO.....----------
USE OF ..........
280-201 Rev. Apr. 691 Signed.....
r,'7?1 .Tn1,, n ;.,o De Geus
Type of Appliance No. Remarks (Check V)
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
Hood and/or Duct
Clothes Dryer
Permit Fee -Z
TOTAL
3®
FEE
Inspected and Approved By
HOUSE GAS PIPING
Number of OuflefsI I Size of Main
FEE 1771
Tested and Approved By