69914 (2) 7561 Prospect
CITY OF SAN JOSE BUILDING DEPARTMENT
/ `APPLICATION FOR GAS PERMIT
Date---------K�- '"---��-.......... ............. I9.�b..!. Permit No-----...C(... L.../-/-..
he unde
of
ofTS n Jose for ad eermifto i'sta`I ad�4le'n�cessh Qo �a pipes dhonCthe
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reverse side hereof, and agrees""to 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. /�� ��0l����/
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. (� f� �( ,
OWNER ------------ Q - . .'.. ...! ^ ' '_ �.. _ _'_' -:.'.. -- - -
n. F . —
... .-
ADDRESS ------------------- ... 150 ..... 3Y C� ----------------
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USEOF BUILDING -------Y .. ................................... ----------- -- --------
FORM 290-20 4/67 tom Signed ....__..... �1-r`uy....... ...... ..........--- ....
7561 Prospect ��1� 11f� West
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