76274 4
4rttAaj6nyva L e Rd. BUILDING DEPARTMENT
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APPLICATION FOR GAS PERMIT
Date----------- ..Z......-....................I 8�� Permit No..-- .L
- The undersigned he by makes a li do o, a bing Inspector of the City of
Sen Jose for a pe /or gas pipes as listed on the
revere side hereof, end a ree: to install id�pliances end/or i �n�n accordance
with the provisions of Article VIII, Chap ofW9jJ�✓/ Code. and
other laws applicable thereto.
OWNER .......... / '! 4=..........GQi{!!5---------------------------_---_------------
ADDRESS ......--------•--•---------•-----.......-----_.
USE OF BUILDING -..-...... /V yOS�L�SS ---..
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Foran team Signed --... --------
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