NO PERMIT NUMBER 875 Lily
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR . BUILDING PERMIT
Date----------
-- ------------------196.6... Permit No-----------------------------------
Applicaishereby made
for a permit to....�X -- -----------------------------------------_---------
a------.-----
at
---- ^sfory, TYPe.—Y""':-.. �,_.._:......_.__----------------------------------------Building
at........ �/- - - -/---i/ ([.- -/--.../-�-------------------------`------------------------------
to be occupiod only as.-----`- ! -/---- -/-'.... --r"---------------------.._-----------------------------
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $./,3. ..
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be com-
plied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any armor so as � become ac� a workman's compensation law: California.
Owne .. .. n. .. � �-a - -- -
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By------
--- vt t41. .... .. .. .....Address.------ --- ----K..............- --- - - - -
�/f/� Contractor, Agent
Form 280.1 875 Lily ,•2 -_/�"';�� Lcma Verde
RECORD OF INSPECTION
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