69915 (2) 7951 Folkstone
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
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Date-------...6—j 3.p...................... 19..67. Permit No------LO F f
The undersigned her 5 k �/� is yi o hf- lumbing Inspector of the City
of San Jose for a pe�ijii'f 61 s> p/ EZnd/or gas pipes as listed on the
reverse side hereof, and a reel to install said appliances and/or pipes in accordance
with the provisions of Article VIII, Chip e , of t1e]S, J se Municipal 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 California. 1 I
OWNER -------------! '..`...:7c.....� `...�-- -------------_------
�1q
ADDRESS -------------------------
USE
.... ..5USE OF BUILDING .--------R-Q....... ......._........................... ...................._....
FORM 280-20 4/67 iom Signed ........... T `-'- ---.-5`2.A.-.J----W st ----_----------
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7951 Folkston 4el71 719•
Type of Appliance No. Remarks (Check
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolafors
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 5
Inspected and Approved By
HOUSE GAS PIPING
Number of Outlets Size of Main
FEE
Tested and Approved By