21100 Building Permit Confirmed In—�'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date..........1::6— 2f---------------------------- 19:7.G- Permit No.-----.....Z41-e-�0...................
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to instal u g if an r pi as st oyµ'a reverse side.
Exemption from r i m for 5�31�e�alff� dM tor's License is hereby claimed
by undersigned. � owner ❑ statement filed ❑
Undersigned attests that his St to of California Contractor's License #
is in full force and affect and prop hori:es this a„py,I.,,ati n.
San Jose City Business License Q- b SF//
I certify that in the performance of the work for wkiA this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER T'✓CG03E LL.
i2✓+�T" ADDRESS 7484 S �u Lot No.`►
�d3'0
USE OF BUILDING-
280-30(9-73)
UILDING 280-30(9-73) Signed .......
7484 KINGSBURy pIACE CENTRAL SERVICE
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