85109 dst3
9 Building Permit Confirmed ❑.
Not Required ❑
CITY OF SAN JOSE 111jmQu<JT .BUILDING DEPARTMENT
APPLICATION FOR MECHANICA}. PERMIT
/
Date...../.'...-/-....--- .... ........... 19- Permit No. - -✓-<-.0-. -- - -------
The undersigned her y makes appica4ion to the Plumbing Inspector of the Cify of San Jose
for a permit 4o install a Gal R1 JJ wo Iso 0 1 ev�6rs side,
Exemption from r e �for\Ste�f,C nia fo�-C tractor's License is hereby claimed
by undersigned: / as owner statement filed a
Undersigned attests that his State of qli dMia Con1fo ' se
is in full force and effect and properly �u3 a�ihis R Z
San Jose City Business License # t
I certify that in the performance of the work fo which this permit is issued I shall not employ
any person in any myv,/ as 4o violate thew en s1c"e�pensa400n laws of California.
OWNER /__L� / /
Lot No.
ADDRESS
USE OF BUILDING_
Signed.% .--- --' - _. . .. --
280-30
842 Kim St. X�- A 7
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