37551 1085 MILKY WAY PHONE: 277-4561
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE . BUILDING DEPARTMENT
APPLICATION. FOR PLUMBING and/or GAS PIPING PERMIT`
Date_._ ..-...5-...................... l9k.IR Permit No....3.7 ...... : .
The undersigned hereb ekes a licafion o t lu bing Inspector of the City of San Jose ,
for a permit }o ins tall �Jm��`� �f' ur i s/^6�^ a reverse side.
Exemption from rage menr tae p, or iR'e fo ntracfor's Licen,e V.hereby claimed
by.'undersigned: as owner ❑ statement filed L�{ }..,
Undersigned attests that his State of C lifornia Contractor's License #
is in full force and effect and properly auth a is ap , j;; �n�"�,,j
San Jose City Business.License # %� 00 ��
❑ I certify /t,h(at in the performance of the work for which this permd is is ued I shall not employ' T'
any person.
OWNER
ADDRESS .L f�_��4 Lot No.
USE OF BUILDING RAS
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