12579 (2)811 Alderbrook Dane
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and /or GAS PIPING PERMIT
/2-- fir— % f—) G/
Date.- - ---- -- ............... -- -- -- --.......--- 19-- -- Permit No.-----/- ---- -- -----I..................
The undersigned hereb makes application to the Plumbing Inspector of the City of San Jose
for a permit To install p in f' ur / pipes listed on The reverse side.
Exemption from r uire n is if w yr ctonse is hereby claimed
by undersigned: s caner s em i d 0. Z,'/ 237 (-•3
Undersigned attests that his fate of California t ct s c s #'
is in full force end effect d properly authorizes This application.
San Jose Ci}y Business tense `� _6 f�
I certify the in the p Irma a of the work r is This�Par ii ue I Ihall not employ
any person in any manne s as m ate the s o ns w aws f aI fornia.
OWNER
SON
ADDRESS Y// 4LPC-1Z 131Z0611 LA Lot No.
USE OF BUILDING (2 L5 �7 //
280 - 30(9-73) Signed _.C./..�C..4!/:: �----��!:`.:GP. � {La,..�........
811 Alderbrook Lane Ace
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