82145 8101 Park Villa Circle
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
/-
Date---�EB..�..----1972........ ....
..... 19.......... Permit No.. �'.�.Z...�.....----...
The undersigned h�erebyeik�sfapplicatiorgto�the,Pl� Bing Inspector of the City
of San Jose for a ppermihito msfalTsei��apiliance�nd �as pipes as listed on the
reverse side hereo4 a?ees to install said appliances and/or pipes in accordance
with the provisions of Article VIII, Chapter 4,1 o the Sarl,Jose Municipal Code, and
other laws applicable thereto. �� r N chI�,th �
I certify that in the performance of The work far which his permi+ji issuecl I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER...M�A/CKAY---HOMES....... ................._.....- .............._................._...._..-----/----d-----
ADDRESSLOT NO.b.Q.......
USE OF BUILDING RESIDENCE... __... - -- - -- ........_._......--.... ...._..._..._ ...
. . ................
MERCURY SHEET - -- - - '�(GO/f ` ,�1 ------------- -
280-20 (Rev. Apr. 69)
Signed.... ... . . ... �/
ln� PnrY Vi 1 1
Type of Appliance No. Remarks (C Teck 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
TOTAL �a
FEE
Inspected and Approved- 2b 92— By ,�I�i�_.rt/�
HOUSE GAS PIPING
Number of Ouflefsj Size of Main
FEE
Tested and Approved By