8034 78911 Be]M&IN(pr. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
�l—�3 APPLICATION FOR BUILDING PERMIT
Date , 19 7 Permit No.
a =Ap lication is hereby made f a permit to t
s or S Use Zone /
at 9/1 e , )r Yy+ ccupancy
to be occupi y as n /; ,4/¢®/S' I Sq. feet
in accordance with Plans,Specifications and Plot-plan filed herewith. Parking Space
Estimated Value of I ovements, $ 00 "`� Fire Sprinkler
Emer. Elect.
I certify that in the oree of th w k oR r wh ch this p i 1 shall not employ any person
in any manner so as to violate the workmen's compensation la^7ws ofC,C'. f�o7rnia.
Owner a Address
By. c Address
1 s
s permit shall expire and b ome n 11 and void if the work authorized by it is not commenced within
12 days from the date issued or if the work is suspended or abandoned for aperiod of 120 days after
commencement. >> I
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