23368 lot /.5, 7623 ELDERWOOD COURT
PlaN3
Building Permit Confirmed—E2'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------------------------------jF-/.(------- 19_7 Permit No.-- 1. ----------------
The undersigned hereby makes application to the Plum ing Inspector of the City of San Jose
for a permit tc ins}all/.�tu� ppp � y'''d�r rP on the reverse side.
Exemption -
f ofe or Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑/
Undersigned attests that his Stafa of California Contractor's License # o0
is in full force and effect andp o Srlq'authori: tis liJ �7Q
San Jose City Business Lic e(
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner sones to violate the/w/orkmen's compensation laws of California.
OWNER PonvWe✓OSA /70'Ves Sri (—
ADDRESS 76123 Ead?�4OO//d Cov/ t Lot No. �S
USE OF BUILDING
280-30(9-73)1 Signed.. YOWL-e---- Q--=-------------------------------
. 7623, ELDERWOOD. COURT CROWLEY CO.
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