91912 1115 19ILKY WAY
UBC 1973.
,Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date �& I c , 19 -7 (0 Permit No.
Application is here6 de fora er ' to
01
a_(j1"g__story, Type 00
_ Use Zone –
a+ %/%//5_ iSX ✓�/q�¢�/ r Occupancy L
to be occupied only a d,(;i� �i����/✓ ce
in accordance with Plans, Specifications and Plo -p�n filed herewi#h. r✓aPrinkler
////// 0 Emer. Elect.
Estimated Value of Improvements, $� "
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any man so es t viol to the workman's compensation laws of Calif;nia.
Owner Address W—CS ��
By Address
RECORD OF INSPECTION
-Founda+ion ' Frame
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Stucco Finish l9 --
1115 MITKY WAX T)ANTEM MARINO 260c601N.
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