4102 (2) 7630 Peachblossom Dr.
CITY OF SAN JOSE q BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT n
Date-------.............M- -y...15---------- 19....7 Permit No.----qCOd�----------------
The undersigned ear b . a�e,,s�applic on�t thnPIumbing Inspector of the City
of San Jose for a per' +-fd4i s alh,!d-appliarces and<r gas pipes as listed on the
reverse side hereof, and 6grees to install said appliances and/or pipes in accordance
with the provisions of Article VIII,-Chlpter 4, of he San Jose Municipal Code, and
other laws applicable thereto. `� /�� �
I certify that in the performanceOr The wor for which this permit is issued
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER....
John Sringuel
- - ......... -----------------.................................... ---------------------------------------------
ADDRESS......763.0.--- mghblossom Drive ____________________ LOT NO..--------------
Sin Family residence
USE OF BUILDING........ ... . - _... ........ ......--
280-20 (Rev. Apr. 69) Signed...�.. & l�%et Metal-- -_Co.
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