71338 7621 Prospect ;#/R
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
7 a
Date....... N25-1968' - 19
---- ---.. Permit No------ ............
The undersigned hereby/rnakesfapplic n f ttke'Plurnbing,lnspector of the City
of San Jose for a permitoi nstallyss2 appliances and%ortga,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 Municipal Code, and
other laws applicable thereto. ��
I certify that in the performance of the ,wo�for which this permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER ... ... .................................................
AD DRESS7L2 - .............................
USE OF BUILDING --- -- -- rte...... ........: ...............
FORM 2e0-20 4/67 10M Signed .._MFRCIIRY SHEET METAL & HEATING, 111ii ----------------
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7621 Prospect Mercury
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