76867 (2) 1655 Sar-Sunnyvale #2
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICA....T...I..ON FOR GAS PERMIT
Date. CN
. �Q c V
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a p �Vlll,
s r gas pipes as listed on the
reverse side hereofCa(dard a es and/or pipes in accordance
with the provisions of Ar 4, of the San Jose Municipal Code, and
other laws applicable thereto. 44r /
I certify that in the performance of work f �71s' s issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California..
OWNER....)O. .j..q. /.L... .... ................... &A
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L�ADDRESS -------- � i
Nf
USE OF BUILDING J /v
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Signed... ... /A/ . -- - -------------------
280-20 (Rev. Apr. 69) JV�-
1655 Sar-SiinmtvAlp #2 L7N 4L-iosuj' i o Meta/awe
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