75065 Cl?�28FFgkke b f Lane BUILDING DEPARTMENT
/ APPLICATION FOR GAS PERMIT
Date..._(D ` � ..---...---..._....... 19.6.(.. Permit No.._�.s. e!-,
----..... -------Is--- ------
The undersigned e y/m,�^ `, a,@pI' -e q ��y bing Inspector of the City
of San Jose fora eenyt�llCa oiaficeYand'/or gas pipes as listed on the
reverse side hereof, and a rees to install said appliances and/or pipes in accordance
with the provisions of Article V Chapter 4, the San Jose umcipal Code, and
other laws applicable there W �
I certify that in the per m ce of the w rk for w ich s permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
Yit'oN.------�..----_/7?/P5�/'T/ ......................_. . . ----------
OWNER.--- -..... ........_ ...
ADDRESS...�4.Z-21----FA_44. 9F_LN..__ . T., LOT NO........------
USE OF BUILDING....... - -------------------- ...... ......
t
280-20 (Rev. Apr. 69) Signed...._ .. . ... . .._.. ...... ._ ............. .
7422 Fallenleaf Lan / N: Forsyth
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