24806 7585 BOLLINGER ROAD
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ----'------------- ---- 19711 Permit No------ �(JV�--------------`--
The undersigned hereb makfT.
i fi 40 umbirp Inior of the City of San Jose
for a permit }o ins#all plu bi g pi es sf wo/h 1�I�s eSs,Or/bv¢rse side.
Exemption from raquir t rni f ni rs License is hereby claimed
by undersigned: ar statement filed ❑Undersigned attests that hisof California Contractor's License, #_34(:147.13
is in full torte and effect and properly authorizes his application.
San Jose City Business License # yd'r — _ k
I certify that in the performance of the work r ihi Per i d I" n employ
any person in any manner so as 4o violate the work en's mpensai o a� s Ca ij,ryia.
OWNER
ADDRESS Lot No.
USE OF BUILDING
280-30(9-73)` Signed-----------
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