81680 885 Ixevra Lane
CITY O' %AN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
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Date/ -"-------13---...---------... 19_.l..�.. Permit No.....SJ../-.`�.j �-- ----
The undersigned hereby makes application to the Plumbing Inspect the City
of San Jose for a permit to install said appliances and/or gas ' as liste n the
reverse side hereof, and agrees to install said appliances a r pi ac r ante
with the provisions Article VIII, Chapter 4, of the Jo nici I od and
other laws applic I thereto.
I certify that i th performance of he or whi t mit is issued I
shall not employ any perso in y m n so s t vi the workmen's com-
pensation laws o Califor
OWNER. C . .. G - `. �.. .. ... .__............_.............. ........---- - ---------- -
ADDRESS.,�-__.�'.�S �ZOOY+�+ ✓LL- .- - -. . .. ........... ..... LOT NO.---- -- ...
USE OF BUILDIIJ6.67�C. C -- -
280-20 '(Rev. Apr. 691 Signed. .'.-Q-`- 171-�C. ---=---11.,4.e_ L -- --- --------- - -
885 I.riie�tnQLaNe �bbin Plumbinct
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