81784 (2) 8062 Park Villa Circle
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIITTT 7
�........._.. 19.------- Permit No......G /... ... �`�
The undersigned hereby makes a plic�tio,rryy�o the.Plumo gJ�spector of the City
of San Jose for a permit�o l'5 ay a dfappplr," ano� as X V as listed on the
reverse side hereof, and QgrooAt install said appliances and/or pipes in accordance
with the provisions of Article VIII, Chapter 4, of the San Jose Municipal Code, and
other laws applicable thereto.
I certify that in the performance of the�wo�for w �t , #his pey'�t issued I
shall not employ any person in any ma4n sows to�ola14ea/workmeI's 0 com-
pensation laws of C lifornia.
OWNER. - _.......
_. . . ...... -...._..-- _....._------.....---—
ADDRESS.�QG. ---� �y... s c -` ..-C� ................. LOT NO.3/...
USE OF BUILDING RESIDENCE....._._.... .....----.------ --........- ......._.._ ...... .........__
280.20 (Rev. Apr. 691 Signed MERCURY SHEET METAL _
8062 Park Villa Circle Mercury S,M
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 �O
Hood and/or Duct
Clothes Dryer
Permit Fee
TOTAL _Ae
FEE
Inspected and Approve —/ _ By
HOUSE GAS PIPING
Number of Outlefsj Size of Main
FEE
Tested and Approved By