36491 7783 LILAC WAY
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATIONFOR PLUMBING and/or GAS PIPING PERMIT
Date................ ( + .................... 19W. --- Permit No.---y&� . ----------------
The undersigned hereb k p }h in s ctor of the city of San Jose
for a permit to install s or as a reverse side.
Exemption from requirement or Stale of California for Contractor's License is hereby claimed
by undersigned: as owner statement filed ❑
Undersigned attests that his State a'fnrpie Con act s ns
is in full force and effect and proper) eut s this Ai
San Jose City Business License
I certify that in tha performance of the work for which this permit is issued I shall not employ
any parson in any nnmanner so as to violate the workmen's compensation laws of California.P
OWNER ude✓t 4E-
ADDRESS
EADDRESS 7783 ILLc c w"'M Lot No.
USE OF BUILDING _
�ignd .. . .........�"--. ... .... - ...._ --....
280-401n
7783, LILAC WAY, R.E. ANDERSON
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