82145 8103 Park Villa Circle
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
Date .FEB...1. 1972 --------- 19------.... Permit No. t� .2 /�{s
---......... .
The undersigned0eby�'a�e��pplita ionrto hie Plumbing Inspector of the City
of San Jose for a�erNit �"'wt.aIhsaid appllig3ces and/or gas pipes as listed on the
reverse side hereof and egrees�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 fo which this permit is issued
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California.
OWNER.MACKAY_HOMES
ADDRESS..CJ��3--- liG Z . �G"-. .L v1G �!.....__..... LOT NO._0......
USEOF BUILDINGRESIDENCE......................._.._.._........._.._...._........ ......... ._.._...._......
AL
MERCURY SHEET ME
. E_
ET � �1 -
280-20 (Rev. Apr. 01 SignedM. .__._........_....._. AL_. .... i ��-...._... .
8103 part Vi 7i - (`i r_la Mnrrnry
Type of Appliance No. Remarks (C Teck V)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
._
Automatic Controls
Flue and/or Vent —
Hood and/or Duct
Clothes Dryer
Permit Fee , P•
TOTAL ar(J
FEE
Inspected and Approved _ f,By
HOUSE GAS PIPING
Number of OuflefsI Size of Main
FEE
Tested and Approved By