81784 8060 Park Villa Circle
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date.�j-a4= 7/............. 19.......... Permit No....r /��/.---�---
The undersigned he etiy a s appl�'lcatio t thq Pumbing Inspector of the City
of San Jose for a permiN�}o nI a'lll/ci app6anG�- a Cor 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 Munici al Code, and
other laws applicable thereto. Alc—
�/.
I certify that in the performance of the work for wkich this permit fs issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER ... . . - -- ..._.................. ...._...- -------
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ADDRESS..C'0...6a.._� -�++%L .z4 . ............ LOT NO.. ....
USE OF BUILDING-RESIDENCE
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280-20 (Rev. Apr. 69) Sign, ERCYR-
Y-SHEET-_METAL XM."./n
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anon Dnrlr vtttA circle a cury �M
Type of Appliance No. Remarks (Ch ck V)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
LCirculating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Automatic Controls
Flue and/or Vent 'ow
Hood and/or Duct
Clothes Dryer
Permit Fee
TOTAL �p
FEE
Inspected and ApproveL- By t
HOUSE GAS PIPING
Number of Outlets Size of Main
FEE
Tested and Approved- By