80826 2918 New Castle Drive
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
O �o.
Date.- _...._. .. ----- ------------ 9/1... Permit No. ... .......
The undersigned he by1,�m s at i t e� bing Inspector of the City
of San Jose for a FrJ��/f/iyi}�5f id+ EsGCrK7lar gas pipes as listed on the
reverse side hereo-1, n� a(q�ees to insta I said appliances and/or pipes in accordance
with the provisions of Atle VIII, Chapt 4, the S Jos M n al Code, and
other laws applicable thereto. ,
I certify that in the performance of the work fof wh" is t is rrmit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California. //-•
OWNER...... ....... --------------------.-----
ADD ...... ..........""... LOT NO.Y __
USE OF BUILDING M".&..MME
70I-248 dB KINGS
\'GSTAL`
ROW
28020 (Rev. Apr. 691 Signed""-. - say-aU.;G`,.CAHF.-ssrt2""""
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