40113CITT OF SANd�]�2.'i"AiitLtlB� ' ' BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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Tract No�6'Z.�----- Lot NOO�.................
Dafe / : �----------- ------- 19�,. ` Permit No.Q�_�I-,� -
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Application is here ado for a permit tor:-- ..... -------------.............._._.._....--..---..a..----!..---story, Ty P ------- ...... ...... ding
Buil
O -- Use Zone . r..-..-..-..
a+../�......... - --- 9 P
j.��� Occupancy ------------------
to
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to be occupied only as ,1....y..�w%/'1irC..... A �f/�f�Parkin Space ..... 2�.........
...
in accordance with Plans, Specifics/ions end/P(lof•plaani e�erewr#h.
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Estimated Value of Improvements, $//_. s..
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with,
I certify that in the performance of the work for which this permit is issued I shell not employ any per-
son in any ner so as to elate f-h�orkman's compensation laws of Celiforma
OwrG�/ 1�' ... t.� A 4' Mud Addres s
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Contractor' [/� (��L' Address `->,- -
ByA9fd7—"" .............. _...........
................. _...........
Form 280-1
RECORD OF INSPECTION
Founda- a� 6--�---R-w._
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