74453 (2) s74$$ to Lane
CITY OF SA JOSE 9 K BUILDING DEPARTMENT
APPLICATIONFOR GAS PERMIT
CC!!//
Date�3.-&------------------------- 19 Permit Permit No......7Y4.7
The undersigned here rya pp' ' of lumbing Inspector of the City
of San Jose for a per # t5 i is es and/or gas pipes as listed on the
reverse Sipe hereof, and agr es to ins�all,said app�a ces and/or is accordance
with the provisions of Article VIII, C }1 r��4, of � J6CGi ipal Code, and
other laws applicable thereto.
I certify that in the performance of the work for which this permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of Cal' nia.
OWNER _/t�. Q/� ..- - Z1 ---
-`.... . ......... - ........
ADDRESS ..7fJ.f ------ o...... .....Com...... ........... . ....
USE OF BUILDING .. . �2L /�� --------------- -- - -------------
FORM 280-20 4/67 10M Signed .. K�%L% �� f... -- .....
7a4n F; ocra T.wno Atlas Heating
Type of Appliance No. Remarks (Check V)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces /
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended- Unit
Floor Furnace
Automatic Controls
Flue and/or Vent
Hood and/or Duct
Clothes Dryer
Permit Fee
TOTAL
FEE
Inspected and Approved By
HOUSE GAS PIPING
Number of Outlets Size of Main
FEE
Tested and Approved By