12291 847 Lilly Ave.
Building Permit Confirmed ❑
Not Required r—ff-
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
/2— a
Date----------------...---//-- -------------- 192V. -
Permit No.------ ------l--- ---'--. ... ---------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Josa
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner psfafem:nt filed El � Fl--2 3.7 C-.36
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify the+ in the performance of the work for which 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 p �C O N , /
ADDRESS O I"IL Y A L/ Lot No.
USE OF BUILDING ��S
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847 Lily Ave. Ace .
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