79220 879 Li-
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
/FOR GAS PERMIT
Q
Date--- ......----------_.. 195L�/. Permit No.....----1-`---/- - O�U
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a permit to install said appliances and/or gas 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.
I certify that in the performance of the work for which this permit is issued I
shall not employ any pparson in any man r so as to violate the workmen's com-
pensation laws of alifornia.
OWNER
ADDRESS ... ---7 --..-------- _'....... ... ....- -......... - ..................._..
USE OF BUILDING ... .... ... .. ........................� r,���G"`_'- 'y
FORM 280-20 4/67 10M Signed ..< - - -- - .-- - - ' .. -/. . -------- /
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879 Lily Ave lloff Atlas
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