75751 (2) JO-210=9 1359 Primrose Way
- CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERM7IT /
Date-----Septertber---34.............. 19.....69. Permit No...../....J�---- 5 l
a The undersigned hereby makes appli�a�on�the Plupg Inspector of the City
of San Jose for a permit✓Qoia al std ap'anc _a��r�q�s pipes as listed on the
reverse side hereof'G4 gfees o nsOl`said'appLances•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 ofhtheotwork for which�thiseperai;tZiMssued I
shall not employ any person in any manner so as�toyiofeteovfhe"dworkrrrlents.com-
j pensation laws of California.
k
OWNER------ Mrs.._.Terry McCann..........__........_....................... -------------------------
ADDRESS......1.359----Privarose Wa O NO.
..._..._..... - ....__......_...
USE OF BUILDING.. -Residence ---- -- ---61VI510f1 N.... ng.. Sfieet Metal CO.,
280-20 (Rev. Apr. 691 Signed ......:. .....:,...-.. .. �� 'i
Cti .::....- .P:.�: . x 637 ......... .
1359 Primrose Way DiviYI{
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