74281 848 Kim
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
3 ..1/_......... - 19.6..9.. Permit No....7.%Z�/
Date............. - ....----....
The undersigned he�,y/�� 1c n t ;Ilg lu/mmW Inspector of the City
of San Jose for a per74ft«J�� ��'�P'P'ZncesA4W'o5 Pipes as listed on the
reverse side hereof, and agrees to install said appliances and/or pipes in accordance
with the provisions of Article VIII, Chapter 4, of the San Jose Municipal Code, and
other laws applicable thereto.
certify that in the performance f th work for "h l]ys ge�A1'h sued 1
shall not employ any person in a so e r s com-
pensation laws of California. [
OWNER BAS,.....L...1S..U.ERAL;.......K.G.L.`E.Y--------------------------------
ADDRESS .......K1.M......ST.............................................................
USEOF BUILDING .....R.. s /.A.1 ..N..0 ......................................................
Ca.
FORM 280;20 4/67 IOM Signed .... .. ...............................................
848 Kim Valley Heating
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