41530 7852 BELKNAP PHONE: 277-4561
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS
/ PIPING PERMIT
.:..--------- 19�, aFPernni+ No.....-L.(,/ .t .3.0............
The unclersi h eby makes a I'caH fo he Tmbin ecfor of the Cify of San Jose _
for a permit } insf g e o pa is reverse sido.
6empfion m q e lif actor's License is hereby claimed
by.undersigned: m as owner ❑ statement filed
s . - Undersigned aft sfs a} his Stet. of California Contractor's License '
is in full force end fect and properly auth ri es fhis ap>�a}ion.
San Jose CilMn;p—,,��Zrm*.nce
nse #I certify that e o ,n • }h s p it sued;I shall not employany person.OWNERfj
e d()may Q� Lo+ No.
ADDRESS —
USE OF BUILDING �= '/
•' , Signed. ----- - -- -- .................... .....
280-401 N t
7II52 BELKNAP E
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