29424 -1128 KENTWOOD
Building Permit Confirmed ❑
Not Required 12/
CITY OF SAN JOSE 1 BUILDING DEPARTMENT
APPLICATION FPR PLUMBING and/or GAS PIPING PERMIT
Date - ... - 19 Permit No.... ./..7...r..L....
The undersigned herb makes ap lication }o the Plumbing Inspecfor of the City of San Jose
for a permit to install p/l ur e T d reverse side.
Exemption from ragQ� fa o actor'sLicense is hereby claimed
by undersigned: ps owner El stat ement filed 'L? 7
Undersigned attests that his Stat f California Contractor's Liconse #
is in full force and effect and prop a fVbrixes Lis p f n `
Sen Jose City Business License lr Z/� Y
I certify that in the performance of the wor for which this permit is • sued I shell not employ
any person in any manner o as to violate fho workmen's compensation laws of California.
OWNER
Lo+ No.
ADDRESS
USE OF BUILDING �` ��J
Sign
L/"L C-- - j ...._.... ...... 01n
ACE
1128. KENTWOOD 2
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