78363 870`1ily Ave
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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
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Date---.a .9.......... 19-70 Permit No....>�4? ........
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-
pensation laws of California. a
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OWNER...... ... ......C..... ......_.. .:_... _.. - ---. ------ ------------
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ADDRESS........ .. - ..(.:..�.�'. .. ....../ �..U...tz ..., LOT NO.._.:c.n.v z
USEOF BUILDING....... -.............-........ ........_...----- -....------- ------
280-20 (R.v.
-----280-201Rsv. Apr. 691 Signed........ ......(%k�..�. ......__-.....-_ ....... _..._-_�-m -
870 Li1V Ave , &M Heatinq
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