19540922 BLAZINGWOOD LANE
Building Permit Confirmed ❑
Not Required - X
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date: -------------/--- ------------ --19%.-6. Permit No..../.�f.:------�.-------------------
The undersigns e b m s a li n IP um
spec}or of the City of San Jose
fora permit }o� s}a g d/o pi s
o the reverse side. -t N
Exemption f(yrf r qu ant f ate a orm, fo
ontractor's License is hereby claimed G'
by undersigned: as owner ❑
statement filed ❑
-� 3iJ''�'�3
Undersigned alias that his State of California Contractor's License #
is in full force and of c} {dti.pro erl or%i%s t a
�;fion
`' ^ 2o2
San Jose City B sin /�/ e /
/ /��
1jf—s/,„Sarsep#
I certify thati e rformanc of fhewo7k for whit
i s permit is issued I shall not employ
any person in any manner so as to violate the workman's compensation laws of California.
OWNER
ADDRESS
Lot No.
V
USE OF BUILDING
280-30 (9-73) Signe ...s '- ------
t 922 BLAZINGWOOD LANE 5
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