81093 (2) 7464, Fallenleaf Lane
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT Q:{
../.. .� 9. .. .. Permit No....���X. .... ....
Date
C �;
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose fora t an s or gas pipes as listed on the
reverse side here e i'safd a pli ces an
pipes in accordance
with the provisions of A icle VIII, Chapt r 4, of the San Jdse Municipal Code, and
other laws applicable thereto. �' � }�
I certify that in the performance of e work for w is this p r is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER.. . .�L .:. .. .....�.._�.._.... ...... .. ....
ADDRESS.. T. -T...'=-....'-' LG NG F ...I,LLOT NO..-----------
USE OF BUILDING ...��..... .........
280-20 (Rev. Apr. 691 Signe -----
7464
.._7464 Fallenleaf La e John Tavlor
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