72675 1163 Stelling
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
7
Date;.. /CC __ ! 7 7/ 0l�/
---.. . . . . - -------.. 19------.. Permit No.... .. ....... .-------------
The undersi ned hereby mak li tlu b' pector of the City
of San Jose for a Permit to in �pes as listed on the
reverse side hereof, and agrees to iall said appliances and/or pipes in accordance
with the provisions of Article VIII, hapter �+�Qf the San Jose MunilRal Code, and
other laws applicable thereto. J /q/ l/
I certify that in the performance of th k fo i is it is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER .... .. .....------- ---[. � .. - ........... -- - -
ADDRESS ---------- - -- ...................... ............. ..... . - . ........
USE OF BUILDING .............X�5.-.t�/Q ��.£C...Ce................................../ /
FORM 280-20 4/6710M Signed ./.Fst. �.- ��-...... ` ---""--""
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