69187 (2) 6715 dliff bH
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date.., .. / (�..._............... I9.c---'7 Permit No..oO. e ........
The undersigned her mak s a li 'on t 'tHe PILwalaing Inspector of the City
of San Jose for a pe i i i plceas pipes as listed on the
reverse side hereof, s to s al i a is e nd/or pipes in accordance
with the provisions of Articl VIII, Chapter 4, of the San Jose Municipal Code, and
other laws applicable there o.
I certify that in the performance of h s p mid issued I
shall not employ any person in any me n s s o e w rlyl4 (e 's com-
pensation laws of al'fDDrnia�. /
OWNER /�(�(1 ........ .. ...... . .......
ADDRESS . 7/. ... - .... --- - —..... ......... - ................
USEOF BUILDING ......................:...................................................................
o,m 18020 IOM 4/6a Signed - -----
- ..... .... ... ---------- -
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