28085 7912 AUGUST &E Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ` ----------------- 197Z Permit No.......d` " 6...
The undersigned he y makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption.from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #-c�n�"���
is in full force and affect and properly e/u}/horixos 4his epplice}ion.
San Jose City Business License #
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 compensation laws of California.
OWNER
ADDRESS f�� �7! Lot No.
USE OF BUILDING A
Signed .i......:/ � .. ,,, zCi.........
�c � X280,401n
91 AUGUST LANE RYAN E GINERING ;?;,t�h
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