38937 6664 CLIFFORn COURT PHONE: 277-4581
• Building Permit Confirmed❑
Not Required, ❑
'CITY) OF SAN JOSE 9 BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or. GAS PIPING PERMIT
Da+eA�.Z e(:...:..................... 1S /
. '14��� Permit No.........��...............7..............
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a-permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed _
Undersigned attests that his State 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 work`or w eh fhis permit is issued I shall'nof employ .
any person.-
OWNER
ADDRESS'_ /`�4' . Lot, No.
USE OF BUILDING'
Signed -----'-----
/- -
• - j� O�J/� 280-40114
664 RT)
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