77469 839 Lily Avenue
CITY OF SAN JOSE BUILDING DEPARTMENT
_
APPLICATION
77FOR GAS PERMIT
Date9-- .....-
..... ......-... 19 4 v Permit No.---- ... .....
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a permit to install said appliances and/or gas pipes as listed on the
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.
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-
pensationlaws f C i nia.
OWNER .....- -------- . -- --------- -------
ADDRESS..�✓.,---------- - .. .................... LOT NO.;--- -------
USE OF BUILDING.-.-.. ..
// .............---- --- --- .
280-20 (Rev. Apr. 691 Signed-- ---- - ..._._._------ ---,1 J--- --- -------
839 Lily Avenue // Selloff Atlas
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