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Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date... - .-- - -...�P------.------ 192�.. Permit No.--------1�W--------------------
The under,i ere *me kes ap licetion to the Plug ii g Inspector of the City of San Jose
for
parmi# to ins#all u elr n the reverse side.
Exemption From r u m t for al -�f/CS( ornia or Con#racfor's License is hereby claimed
by undersigned: as o ner ❑ statement file
Undersigned attes#s that his Sf a /s—//�-��li{orni y#�r� r�c/ s
is in full force end effect and Prop;e�auThorixe f m app¢a iI f o'n✓ /
San Jose City Business License # V 6---a Z12
I certify the+ in,the performance of the work for which this permit is issued I shall not employ
violate the workmen's compensation laws of California.
manner so as }o P
any person in any
OWNER :: /FA
ADDRESS U O Lot No.
USE OF BUILDING
280-30 (9-73) Signed..(//\.�X`l-L.h--- - -- """
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