28871 7786 LILAC WAY_
j,
Building Permit Confirmed,Q_
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBI G and/or GAS
PIPING
7 PERMIT
Da+e........ ..kj,.",C.....�,3........... 19.� Parmi+ No.....O ..D.. 1. ...._..-------
The un8ersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plu n fi ur e / i revorso side.
Exemption from req r f rector's License is hereby claimed
.. by undersigned: owner sfa}amen# filed ❑ _
Undersigned attests that his $tate of California Contractor's License #
is in full force and effect and properly fhi�liti
San Jose City Business License # s
Z,w
I certify that in the performance of the work for which this permi is�ss.ed I shell not employ
any person in any manner so as to violate }hie/workmen's compensation laws of California.
OWNER //t X/ < ST/l✓Et�
ADDRESS 77�C �� C 1�iit Lot No.
USE OF BUILDING ✓• /
Signed ... ll.lad ... .... : .....�------ ..
�fyi�lJ l v r0105;7-, /ivC,
-280,4oin
7766 LILAC WAY FAIRWAY CONST
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