3861 1110 14ilky Way: .
CITY OF SAN 'JOSE 61 BUILDING DEPARTMENT
APPLICATION IFOR GAS PERMIT
Date....... Rt1-------AA...... 19..'.1.x.- Permit Not ? ---/......
The undersigne r b s pli bn to mbing Inspector of the City
of San Jose for plr�re /or gas pipes as listed on the
reverse side hereof, an agrees to install said appliances and/or pipes in accordance
with the provisions of Article VIII, C pt 4, of-the San J e Municipal Code, and
other laws applicable thereto. _//� ��i
I certify that in the performan o the w r r wh termit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation la�s of California.
OWNER .........or_....(�y0_. a6woo.vl.......................................... ---------
ADDRESS.....\)NO.....\-Y-."A\ 1N...... ............... LOT NO...... .....
e' ` l
USE OF BUILDING...... etc- ile\ t nc—eco............ ........................ \....:_�./... .....�R.
280-20 (Rev. Apr. 69) Signed-vzkeQX1....P%v-._.�.m.)(ne�-r.�---.J.,_t��c. -� -
1110 Millcv Way Western A/C.
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