82147 8061 Park Villa circle
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT �!
Date-FE R.---........IM------------ 19-------- Permit No...V..-�- �.T...
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a per itto install saidjapplianpes,�a�n�d�r7gas pipes as listed on the
reverse side hereof, a�d�gree�§��to iisjalIII idZbpp'I'p�egs&.and/or pipes in accordance
with the provisions o(�Article�Vlll, Chapter 4, of fhe San Jose Municipal Code, and
other laws applicable thereto.
I certify that in the performance of the work for which this permit is issued I
shall not employ anyperson in any manner 5o as^to viol to workmen'sthscom-
pensation laws of California.
OWNER..MACKAY HOMES
..p...__..r...-....... -- _. ................................_................ . --------- ............. ........
ADDRESS )�4.o "`.:. sf, - LOT NO....FY---
USE OF BUILDING.RESIDENCE .......... .. ............... _. -__ . .._ . ..-- -
280-20 (Rev. Apr. 69)
Signed MERCURY SHEET.ME:[AL,7..�4G' :/ � o
8061 Park Villa Cirrle Mercury
Type of Appliance No. Remarks (Check V)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Automatic Controls
Flue and/or Vent
Hood and/or Duct
Clothes Dryer
Permit Fee I ��
TOTAL pp
FEE 6-1
Ins ected and Approved � - By
HOUSE GAS PIPING
Number of Outlefsl I Size of Main
FEE
Tested and Approved By