48638 801 Miller Ave.
Building Permit Confirmed �210�
Not Required ❑
CITY OF SAN JOSE AIJILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT Q Z
D a f a--Qct... --//LI-.......--. ----------- 19!Z Pernnif No._ Q... 3 v
The undersigned hereby makes application to the Electrical Inspector of the City of San Jose
for a permit to install electrical fixtures and/or wiring as listed on the reverse side.
Exemption from requi.rervent for State of C nia for Contractor's License is hereby claimed
undersigned: '3s owner ❑ state fn filed
Undersig d a s} hal his f of iforni C } }ors i ens
z in f II r i c pr ply th .:az } 's p ce ion.
�n Jose ify usiness License .1j "
I certifyat in the performance of the work for which this permit is issued I shall not employ
any person in ny manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESSQJ UJ 1 FR y� 70C[y
Uvw �L
USE OFF BUILDING
FIRM�L "��1�
� ye SIGNED `
280-201n
801 Miller Ave. Midland Elect.
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