38151 AV OF SAN JOSEd'�-�h-46i��'� P"db-F'BUILDING DEPARTMENT
7
APPLICATION FOR BUILDING PERMIT
Date- -,7.,? 15
--------------------------- 10� Permit No-3- -s' 17---------------------
Application is hereby,,mafor a permit t� --------------- --------------- ----- ------ -
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pe� de ----------- -- ------------ ---------- -------------------- Building
-------- -- ----
to 6eoccupied only
in accordance wN !ci at and RefraVWIQ�2.e--
Estimated Value of improvements $/ 1 ------------- -------------
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 shall not employ any per-
son in any manger so as to violate the workman's compensation laws of California.
Ovm'e�rg�,-�-)664444 f
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LIZ
By Y '2
-C---------------Address, ----- ----------------------------------
Contra cfor�Ag ant
Form 280.1
RECORD OF INSPECTION
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