1158 D0 1661 Galaway
Buildingit Confirmed C]No} Required
✓=r--
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL /PERMIT
Date.... .. /✓................-. 19.~x-3 Permit No.------------/.�J'.-- -----------------
The undersigned makes��{a++ep lie flon to the Plymbin9 Inspector of the City of San Jose
fore permit to install 'W iis r� rt�jo ��J veS e.
Exemption from rtgprr6rrf } }e o4 6eh rn fo ratter's License is hereby claimed
by undersigned: s owner ❑ statement filed ❑
Undersigned attests that his SfatV California Co r cf rst ce
is in full force and effect and prop aµt&er<ses n�
San Jose City Business License �i`eZ..,j
I certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER�CLL
ADDRESS 14O_40_� LSKC[J� �fI/l1 n. Let No.
T ANE Ylil r4F✓B 11Lw✓" � �V
704 L. Gish Road Signed------.. '----
zeo-g§n Jose, California 95112
l tir-ll4W 9,9A-3554 Trance
Type of Appliance No. Remarks (Check V)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Fired Boilers
Blower Furnaces
Suspended Units
Clothes Dryers
Flue/Vent /
Hood/Duct
Misc. FEES
Appliance Fee
(�(J Flues/Vents Fee
Hood/Ducts Fee
Gas Piping Fee
Permit Fee
M " / - 0o
TOTAL FEE
Cn -U v
INSPECTION RECORD
DUCTS
APPROVED
BY
FLUES
APPROVED
BY
APPLIANCES
APPROVED
BY
GAS LINE
NO. OF LINES OUTLETS SIZE
TESTED AND APPROVED
By