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77855 (2) 1181 Elmsford CITY OF SAN JOSE 4l BUILDING DEPARTMENT APPLICATION FOR GAS PERMIT �s s Date� ....�j.�.......... .. I9..Y�.� Permit No.....--~� -- ........ Th A'undersigned here y mak s a�,p�plica iionn lo,the� bing Inspector of the City of San Jose for a per�t( in 1LUJ ' c� ` " gas pipes as listed on the reverse side hereof, and agr es to install said appliances and/or pipes in accordance with the provisions of Article VIII, C ter 4, of the San Jose Municipal Code, and other laws applicable thereto. `flj�� I certify that in the performance he o r wh s permit is issued I shall not employ any person in any manner so as to violate the workmen's com- pensation laws f Califfornia OWNER � ...ry!/.�... .uyr/P± �i1/Yl• ... ....... ................ ......................... ADDRESS./.I--r��_lG.. . .. . _l S..p _......._......._.. LOT NO...--------.-- - _ - - USE OF BUILDING-- � ............ ................ .......... - -.--- --...__..... .4'JZ ,rte py, �j 280-20 (Rev. Apr. 691 Signed ---------------- - 1181 Elmsford R&R Plumbing :. m ? , p O c c oI m 0 a o a y a CL Ir 0 m ' m e dam' 3 a �• T a = a TCL D pC: o_ m Oa < 0 µ N m --1 m D i > o a m Z \ \ o N n1 � W O � 3 a ° a