18190 854 Lily Avenue
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------ -----------------------1(1--Z-K-- 1 19. Permit No.----- ..2i9-------------------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
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 ❑ statement filed El
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 # 7 & —/ S-/12-
1 certify that 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 >12vA/6
ADDRESS ky`/ 1 /� 7` Lot No.
USE OF BUILDING /Z
280-30(9-73) Signed ..........----------------------------
854 Lily Avenue. Kajo
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