77703 853 Lonna Lane
CITY OF SAN JOSE BUILDING DEPARTMENT ;
7l
APPLICATION FOR GAS PERMIT
Date...... .�.� .----------- 19--- Permit No.2.L..IT_77.,z)....
The undersigned hereby makes application to the Plumbin nspector o ify
of San Jose for a permit to install said appliances and/or 9 is on the
reverse side hereof, and agrees to install said applia o p' ac rdance
with the provisions o Article VIII, Chapter a San os uni 'pa ode, and
other laws applic thereto.
I certify that in t per or nce he o for 'ch this permit is issued I
shall not'emplo any Pers i an a o violate the workmen's com-
pensation laws f Califor
OWNER .-- .LO.... ......... . _.. ......... t�
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............. LOT NO. - ......ADDRESS ' 3... � .... .. ... ...
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USE OF BUILD ING........... �"`�.... ' ......
280-20 (Rev. Apr. 69) Signed._. '= - "- -
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