69914 (2) 7573 Prospect
CITY OF SAN JOSE BUILDING DEPARTMENT
/ APPLICATION yFOR GAS PERMIT MJ /
Date-----1'��-I°`--q---------................ 19 ....' Permit No.-----4P..------./...1....
The anderslgne�h'ereby makes application to the)Plumbing Inspector of the City
of San Jose fo�,p6rmrfa��s�I\sa��ppha/Viand/or gas pipes as listed on the
reverse side hereof, and" grees to insfallisdid 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. [pJ /� ��f i
. I certify that in the performance�of the workjfoi4hich/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 ...............R-' . .......! v.-----4�.. ...
ADDRESS ----------------- ----- ... 75-7.....------ ........................._--
USEOF BUILDING -------...44-�.... ............... .......... ------------------------
FoaM zeo-zo 4ie7 IoM Signed .._...�__IOLIQ .5S`2-�.....� s . --------------
7573 Prospect /,dkrz �{q
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