105647504 KINGSBURY PLACE
CITY OF SAN JOSE
Building Permit Confirmed ❑
Not Required ❑
BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date -----------�--4-----......-----...... 19.%.%_ Permit No.. /_-s� `-----------.:.
The undersigned hereby ^ ke�s�p 'on } tho ugnbing Inspector of he City of San Jose
fora permit to install the nKcGCn1Si9/�/S� ar si
Exemption from req uiremeni f tate of a if role• or actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # /7/.-77
is in full force and effect and properlyrae this appliicat,
San Jose City Business License $k —0i7 yy��//:��M ]c
I certify that in the performance of e au owM for which this permit is issued rshall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER l2trNELL
Yn a�T ADDRESS -74-"04 �r N Sy o t Lot No. 4
S48o
USE OF BUILDING n
Signed ..... �J1i2'X_� .!2hQ11;lL-�D.�_ S!f2G.....
280-20 16731
7504 KINGSBURY PLACE CENTRAL SERVICE
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