12283 &77.BOLLINGER ROAD
Building Permit Confirmed ❑
Not Required ❑
CITY OF 1SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date..�1.QbE.-------G--------...... 19../ Permit No.-----/. -_------------
The undersigned hereby makes application to the Pluming Inspector of the City of San Jose
for a permit 4o install the a hanical k 4 n r or si
Exemption from raqui a 4 or for fo� n}r t r License is hereby claimed
by undersigned: a o er to eme filed P� n
Undersigned attests that his Sfat of California Contractor's License'#
is in full force and effect and properly authorizes this application.
San Jose City Business License # —
1 certify that in the performance of
the k 'which A' er is 's ed sal{ o a ploy
any person in any manner so as to violate }Ike nes co ti , of al n a.
OWNER e r
ic
ADDRESS t17 �C Lot No...
USE OF BUILDING
Signed - -�-�� ----�-- '�---�--'
zeo-zo I6-73I �¢ F SHEET MTA IC IAd ", CA.
6577OLLINGERIROAD B f
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