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69915 (2) 7985 F619stbad CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR GAS PERMIT Date.._ ---------------------------- 19_ .7 Permit No... ./..../e The undersigned hereb makes �gpl'�atio t t � mbing Inspector of the City of San Jose for a perp tf's pli s d/or gas pipes.as listed on the reverse side hereof, an agr es to instal said appliances and/or pipes irLaccordance with the provisions of Article VIII, Chapier _the Sp� i Vn�I de, 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. OWNER ------------ . _1 ... - (( f................ ADDRESS --- - ------ `.- ..................... USEOF BUILDING ........L13..'.................._....---------- ------------- .................... FORM 280-20 4/67 10M Signed -------- . ' SZk'i'`D 7985 Folkstone /,/Ply /,/meq West Htg Type of Appliance No. Remarks (C eck V) UNewRelplace ;Relocafe Gas Ranges Wall Heaters Gas Plates Circulating Heaters Blower Furnaces Gas Fired Boilers Warming Ovens Percolators Griddles Sfeam 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//�`'f A 7 By HOUSE GAS PIPING Number of Outlets Size of Main FEE Tested and Approved By