78153 7565 Waterford .
CITY OF SAN JOSE / BUILDING DEPARTMENT
1
APPLICATION FOR GAS PERMIT
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Date- !� /�........_.. 19--70 Permit No. ,1...�.. ........
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a pe li and/or gas pipes as listed on the
reverse side.hereof, ees s id ppliances and/or pipes in accordance
with the provisions of Ar icle VIII, Chap^ter 4, of the San Jose Municipal Code, and
other laws applicable thereto. A0e �j $-/6; C(/
I certify that in the performance wo ch i ermit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
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OWNER ......._-.. .._.. - - _.o..T
ADDRESS........ / GS...G�/� _aZrJ.v.�.�....._.. ..._...-. LOT NO----...�.n.oZ �
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USEOF BUILDING----------I:C^---- - - ...._........._.........-................................
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280-20 (Rev. Apr. 691 Signed------------C.&� ------_..-------
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