41191 $01 MYYY,EIi AVENUE 16i�
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLI ATIO FOR PLUMBING and/or GAS PIPING PERMIT
.J q
Date-- --��.. ........._._._.................. 19� Permit No.-----......y�l/-.�.......--------
T a under gned hereby makes application to the Plumbing Inspector of the City of Sen Jose
for a permit to install plumbing fixtures and/or ' s listed on the reverso side.
Exemption from re uirement for State of Calif rnie or Contractor cense is claimed
by undersigned: as ow er ❑ fa}em n fi d /
d ig ests that rs o alifornia ont'a r' Lice a (O
i in f f of an p po orixes }hi pplication.
ose�tysines License # -O' �{ b
I c ify that in th performance of the work for which this permit is issued I shall not employ
any pers n in any me ner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS ej Lot No.
USE OF BUILDING
Signed- -. ..yTw•. �t.. ... �, --,il ....-
280-401n
801 MILLER AVENUE FOOTHILL PLBG.
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